Market Liaison Support Services Analyst II

Job Summary:

Market Liaison Support Services Analyst II is responsible to work the daily inquiries coming into Operations through the common intake process.

Essential Functions:

• Conduct end-to-end research on assigned MLSS Operation Intakes working with all necessary departments as applicable to the issue, including but not limited to contracting, credentialing, provider data management, claims, configuration, enrollment, utilization management, finance, payment integrity, policy, member benefits, IT and other operational/enterprise departments Review, facilitate, document and complete holistic analysis of the intake by following proper change controls, Standard Operating Procedures and other supporting documentation on steps to ensure root cause resolution
• Participate in User Acceptance Training (UAT) of system issues identified during end-to-end research of MLSS Operational intakes
• Lead market projects, escalations, regulatory inquiries and state complaints/inquiries
• Lead training sessions including assisting in the training and development of new hires and continuous training/mentoring of the Associate Market Liaison Support Services role
• Lead or participate solution sessions with providers and the market when necessary, including supporting the provider or market via emails or internal/external phone communication.
• Attend and support internal/external meetings in conjunction or in place of leadership as needed
• Assess and generate reports to determine claim impact to aid in research
• Prepare and publish reports summarizing trends with issues, including research performed, root cause analysis, and resolution performed or needed
• Incorporate critical thinking skills, discretion and independent judgment into the analysis process to determine best course of action for each inquiry/problem
• Assist the market proactively evaluate risks and develop risk-mitigation actions
• Communicate effectively with various internal departments to enhance cross-functional awareness, promote process improvement, and identify root cause resolution of issues
• Build strong cross-functional working relationships with operational departments, markets, support partners, and other areas in which collaboration is essential for resolving issues and driving improvements
• Perform any other job duties as requested

Education and Experience:

• Bachelor’s Degree or equivalent years of relevant work experience is required
• Minimum of two (2) years of experience in a managed care environment is required
• Minimum of two (2) years of experience in managed care operations is required

Competencies, Knowledge and Skills:

• Knowledge of Medicaid/Medicare and familiarity of healthcare industry
• Overall understanding of one or more key Healthcare systems, including Choreo, Cactus is preferred
• Facets knowledge required
• Advanced troubleshooting and problem-solving capabilities with attention to detail
• Root cause with data analysis preferred
• Overall knowledge and understanding of Managed Care Operations-related systems, medical coding, technical specifications, and processes is required
• Strong critical thinking skills
• Ability to understand and determine adherence to accreditation and regulatory requirements
• Ability to multi-task while dealing with several escalations
• Ability to analyze processes and develop clear recommendations for remediation
• Solid understanding of claims processing is required
• Thorough understanding of medical claim configuration is required
• Proficient in Microsoft Office Suite specifically Word and Excel
• Understanding of provider setup is preferred
• Excellent verbal and written communication skills
• Effective relationship management skills
• Effective organization and prioritization skills
• Ability to manage time effectively
• Effective facilitation
• Strong interpersonal skills and high level of professionalism

Licensure and Certification:

• None

Working Conditions:

• General office environment; may be required to sit or stand for extended periods of time
• Maybe required to travel, estimated at less than 10%

Compensation Range:

$61,500.00 - $98,400.00

CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.