Looking for a way to make an impact and help people?

PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, national origin, sex, sexual orientation, gender identity or age.

Diversity and Inclusion : PacificSource values the diversity of the people we hire and serve. We are committed to creating a diverse environment and fostering a workplace in which individual differences are appreciated, respected and responded to in ways that fully develop and utilize each person's talents and strengths.

Participate in the identification and implementation of solutions, which results in efficient, accurate, and quality configuration, and maintenance of Facets.

Ensure timely configuration and implementation of selected solutions as directed by your trainer or mentor within your FBS team.

Accountable for complying with all laws and regulations that are associated with assigned duties and responsibilities.

Essential Responsibilities :

• Assist with design of new configuration to support business needs and functionality.
• Accurately update, implement and test configuration changes as assigned by trainer.
• Assist with analyzing business requirements, test plans, training materials and procedure documents.
• Assist with executing test plans and test case scenarios to ensure requirements are being met.
• Participate in development of detail design and system walk through with respective teams to verify design and solution meet business and system requirements.
• Assist and work with business areas for the review of all reported system defects.
• Monitor, research, and resolve claims related ServiceNow tickets designated for a Configuration Analyst I. These include class plan related claims issues, assistant surgeon claims, UM requirements and others as assigned by trainer.
• Assist with diagnosing and resolving system configuration problems. Begin to understand troubleshooting techniques and methods at a fundamental level.
• Responsible for quality assurance tasks. Double check your work to ensure accuracy.
• Develop an understanding of Facets Batch Logs, with the ability to troubleshoot issues as needed.
• Process, troubleshoot and resolve claims in the FBS Claims queue in a timely manner to satisfy turnaround time requirements.
• Create and maintain Service ID's and Explanation Codes.
• Develop understanding for all claims mapping tables and assist in mapping updates.
• Develop understanding of our Clinical Editing System (CES) and assist in ongoing updates
• Support in special projects as assigned.

Supporting Responsibilities :

• Interact with business leaders and users, including external partners and customers as required. Maintain professional, service oriented relationships.
• Demonstrate ability to organize and prioritize work.
• Meet department and company performance and attendance expectations.
• Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.
• Perform other duties as assigned.

SUCCESS PROFILE

Work Experience :

Minimum two years of relevant experience in health plan environments with at least one year experience with benefit plan administration required.

Experience working with Facets is preferred.

Education, Certificates, Licenses :

Associates Degree or equivalent combination of work experience and education required. BA / BS degree or ICD-10, CPT, HCPC coding knowledge preferred.

Knowledge :

Extensive knowledge of industry standards and internal PacificSource, PacificSource Medicare, policy and processes. Proficiency in Microsoft systems Outlook, Excel and Word.

Experience in database systems of Access and / or SQL also preferred. Strong analytical and problem solving skills. Excellent interpersonal skills including verbal and written communication.

Ability to work collaboratively as a team with little supervision.

Competencies :

Building Customer Loyalty

Building Strategic Work Relationships

Contributing to Team Success

Planning and Organizing

Continuous Improvement

Adaptability

Building Trust

Work Standards

Environment :

Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 5% of the time.

Skills :

Accountability, Collaboration, Communication (written / verbal), Flexibility, Group Problem Solving, Listening (active), Organizational skills / Planning and Organization, Teamwork

Our Values

We live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business :

• We are committed to doing the right thing.
• We are one team working toward a common goal.
• We are each responsible for customer service.
• We practice open communication at all levels of the company to foster individual, team and company growth.
• We actively participate in efforts to improve our many communities-internally and externally.
• We actively work to advance social justice, equity, diversity and inclusion in our workplace, the healthcare system and community.
• We encourage creativity, innovation, and the pursuit of excellence.

Physical Requirements : Stoop and bend. Sit and / or stand for extended periods of time while performing core job functions.

Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English.

Communicate clearly and effectively.

Disclaimer : This job description indicates the general nature and level of work performed by employees within this position and is subject to change.

It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position.

Employment remains AT-WILL at all times.

Last updated : 2024-05-21