Market Liaison Support Services Analyst II

CareSource Management Services LLC • Dayton, OH • 3d ago

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

Similar Jobs

Business Development Director - Arrow Global Supply Chain Services

Arrow Electronics • Dayton, OH • 2h ago

Management & Administrative

Position: Business Development Director - Arrow Global Supply Chain Services Job Description: Arrow Global Supply Chain Services offers a compelling suite of supply chain services to clients ultimately to optimize, bring...

2h ago

Go to Apply

Manager Software Engineering

Leonardo DRS, Inc. • Beavercreek, OH • 21h ago

Management & Administrative

Job ID: 112150 The Leonardo DRS Airborne and Intelligence Systems business is a global leader and strategic partner committed to delivering world-class, full life-cycle defense and intelligence products that protect the...

21h ago

Go to Apply

Customer Service Representative - Kendall Electric

Kendall Electric • Dayton, OH • 1d ago

Management & Administrative

Customer Service Representative About Kendall Group Kendall Electric, a division of The Kendall Group seeks a talented, creative, self-motivated individual for the Customer Service Representative position. The Kendall Gr...

1d ago

Go to Apply

IT Requirements/Transition Manager

Riverside Research Institute • Dayton, OH • 1d ago

Management & Administrative

IT Requirements/Transition Manager Location US-OH-Dayton ID 2025-3816 Category Information Technology Position Type Full Time Salary Riverside Overview Riverside Research is an independent National Security Nonprofit ded...

1d ago

Go to Apply

Senior Manager, HR Operations & Supply Chain

Avery Dennison • Miamisburg, OH • 4d ago

Management & Administrative

Company Description Avery Dennison Corporation (NYSE: AVY) is a global materials science and digital identification solutions company that provides a wide range of branding and information solutions that optimize labor a...

4d ago

Go to Apply

AFLCMC/WA/WB Operations Manager (Facility Management) (Dayton OH)

DCS CORPORATION • Dayton, OH • 4d ago

Management & Administrative

Manage and support government facility operations, including overseeing daily operations, directing workflow, and ensuring adherence to policies and procedures. Provide on-site support to AFLCMC/WA/WB located at WPAFB in...

4d ago

Go to Apply

Administrative Assistant FOG

Credence Management Solutions LLC • Dayton, OH • 4d ago

Management & Administrative

Administrative Assistant FOG Job Locations US-OH-WPAFB ID 2025-9249 Category Other Type Regular Full-Time Overview At Credence, we support our clients' mission-critical needs, powered by technology. We provide cutting-ed...

4d ago

Go to Apply

HVAC Service Tech Apprentice

Logan A/C & Heat Services • Dayton, OH • 4d ago

Management & Administrative

HVAC Service Tech Apprentice Logan A/C & Heat Services Vandalia, OH 45377 We are thrilled to announce that our apprenticeship is now Trane accredited! Starting at $19.00, wages increase with each apprenticeship phase...

4d ago

Go to Apply

HVAC Service Tech Trainee

Logan A/C & Heat Services • Dayton, OH • 4d ago

Management & Administrative

HVAC Service Tech Trainee Logan A/C & Heat Services Dayton, OH 45377 We are thrilled to announce that our apprenticeship is now Trane accredited! Starting at $19.00, wages increase with each apprenticeship phase comp...

4d ago

Go to Apply

Account Manager

Avery Dennison • Miamisburg, OH • 4d ago

Management & Administrative

Company Description Avery Dennison Corporation (NYSE: AVY) is a global materials science and digital identification solutions company. We are Making Possible products and solutions that help advance the industries we ser...

4d ago

Go to Apply

Subscribe to get new jobs sent directly to you
(no charge, cancel anytime)

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.