Overview
Remote
Hybrid
BASED ON EXPERIENCE
Full Time
Contract - Independent
Contract - W2
Skills
HEALTHRULES
HEALTH RULES
HEALTHCARE
HEALTH CARE
PAYOR
Job Details
Position: Configration Lead
Location: US (Remote - Need to travel to client location when needed)
Duration: Long Tem
Configuration Lead, you must be highly organized and detail-oriented, with strong analytical, problem solving, and prioritization skills. You should also be able to handle multiple tasks in a fast-paced, deadline-driven environment, both independently and as part of a team. It is also important that you display excellent verbal and written communication and interpersonal skills, as well as the ability to effectively present information and respond to questions from groups of managers and clients.
Mandatory Technical skills: -
Healthcare Payor business functions and IT systems
Good knowledge of US health care and payor business functions
Understanding of US Healthcare Payor work-streams including Claims flow, Claim Adjudication, Provider Management including Network Set-up, Provider Pricing Contracting Rules, Medical Management, Premium Billing and Payments, Member Enrollments, Benefits Management
Strong knowledge on Medicare Eligibility and Set-up in HRP, HIPAA X12 transactions 837I/P/D, 834, 270/271, 835
Well versed with various lines of business Commercial, Medicare, Medicaid, ASO, HIX and Fully Insured etc.
Healthcare industry standards and codes usage ICD-10, HCPCS, CPT, DX, POS, Bill Type, Revenue Codes, DRG Pricing, APC Pricing and NDC etc.
Knowledge on any of the Core Administrative Processing Systems (HealthRules, Facets, and QNXT, etc.)
HealthRules Benefits Configuration: Set up Benefit Plans using wizards and BP templates for plan creation
HealthRules Supplier Contracts configuration: Good knowledge on Provider Networks and Supplier Contracts (Confinement Rate, Fee Schedule, Fee Component, Bundled Payment, Capitation), Providers (Supplier & Practitioner), Enrollment, Premium, Account, sub-accounts, etc.
Skills: -
Hands-on HealthRules (HealthRules Designer & HealthRules Manager) configuration experience; Contract Pricing
Responsibilities: -
Interacting with customers, internal stakeholders and other third-party vendors for requirements gathering, architecture and design discussions, development, testing and other activities
Implement HealthRules as claims adjudication system and integration of HealthRules with existing application ecosystem
Responsible for architecting, designing and deployment of HealthEdge HRP components in implementing a Claim administration system
Understand HealthRules API and Connector services and can integrate HealthRules with required applications
Support / guide data profiling and data migration from other claims systems (Facets, Amisys, QNXT, etc.) to HealthRules system
Documentation of project deliverables and versioning
Mentor and guide team on technology, frameworks, processes and ensure quality of deliverables
Support testing and deployment of HRP solutions
Architect, design, code, test and document interfaces of moderate-to-high complexity as per the requirement specifications
Mentor and guide team on technology, frameworks, processes and ensure quality of deliverables. Support testing and deployment of HRP solutions
Educational Qualifications: -
Bachelor's degree in computer science, information technology or a similarly relevant field is highly preferred.
Location: US (Remote - Need to travel to client location when needed)
Duration: Long Tem
Configuration Lead, you must be highly organized and detail-oriented, with strong analytical, problem solving, and prioritization skills. You should also be able to handle multiple tasks in a fast-paced, deadline-driven environment, both independently and as part of a team. It is also important that you display excellent verbal and written communication and interpersonal skills, as well as the ability to effectively present information and respond to questions from groups of managers and clients.
Mandatory Technical skills: -
Healthcare Payor business functions and IT systems
Good knowledge of US health care and payor business functions
Understanding of US Healthcare Payor work-streams including Claims flow, Claim Adjudication, Provider Management including Network Set-up, Provider Pricing Contracting Rules, Medical Management, Premium Billing and Payments, Member Enrollments, Benefits Management
Strong knowledge on Medicare Eligibility and Set-up in HRP, HIPAA X12 transactions 837I/P/D, 834, 270/271, 835
Well versed with various lines of business Commercial, Medicare, Medicaid, ASO, HIX and Fully Insured etc.
Healthcare industry standards and codes usage ICD-10, HCPCS, CPT, DX, POS, Bill Type, Revenue Codes, DRG Pricing, APC Pricing and NDC etc.
Knowledge on any of the Core Administrative Processing Systems (HealthRules, Facets, and QNXT, etc.)
HealthRules Benefits Configuration: Set up Benefit Plans using wizards and BP templates for plan creation
HealthRules Supplier Contracts configuration: Good knowledge on Provider Networks and Supplier Contracts (Confinement Rate, Fee Schedule, Fee Component, Bundled Payment, Capitation), Providers (Supplier & Practitioner), Enrollment, Premium, Account, sub-accounts, etc.
Skills: -
Hands-on HealthRules (HealthRules Designer & HealthRules Manager) configuration experience; Contract Pricing
Responsibilities: -
Interacting with customers, internal stakeholders and other third-party vendors for requirements gathering, architecture and design discussions, development, testing and other activities
Implement HealthRules as claims adjudication system and integration of HealthRules with existing application ecosystem
Responsible for architecting, designing and deployment of HealthEdge HRP components in implementing a Claim administration system
Understand HealthRules API and Connector services and can integrate HealthRules with required applications
Support / guide data profiling and data migration from other claims systems (Facets, Amisys, QNXT, etc.) to HealthRules system
Documentation of project deliverables and versioning
Mentor and guide team on technology, frameworks, processes and ensure quality of deliverables
Support testing and deployment of HRP solutions
Architect, design, code, test and document interfaces of moderate-to-high complexity as per the requirement specifications
Mentor and guide team on technology, frameworks, processes and ensure quality of deliverables. Support testing and deployment of HRP solutions
Educational Qualifications: -
Bachelor's degree in computer science, information technology or a similarly relevant field is highly preferred.
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