Job Description
Overview
of Daily Tasks:
• Implement the pricing and benefits configuration, maintaining requirements documentation including design documents, business decision logs, meeting minutes, testing scenarios, paper configuration sets, error tracking logs, transition documents and any other tools utilized to configure and maintain the system.
• Analyze customer requirements, including professional and institutional provider contracts and apply your expertise of payment methodologies, to design configuration for optimal claim auto-adjudication and accuracy.
• Participate in discussions and business requirements definition with internal and external customers for requests and projects, ensuring the successful delivery of configuration services
• Provide timely and accurate completion of configuration change requests, maintaining proper documentation and identifying effective control standards of system configuration changes.
• Create, document and execute test cases based on implemented system configuration and customer's expected results.
• Apply your experience in claims processing and claims billing practices to evaluate claims data to design configuration and to problem solve claims processing issues related to possible pricing and reimbursement errors.
• Mentor less experienced team members including but not limited to configuration and pricing expertise, business rules, and business processes
• Troubleshoot system and claim processing errors, determining root cause and corrective actions required
• Participate in project activities across cross-functional teams related to pricing configuration, requirements implementation, defect resolution, and impact reporting
• Use your domain expertise to proactively identify, recommend, and drive process improvements including automation, enhanced process controls, and process redesign, while considering industry best practices and customer expectations
Knowledge, Skills, & Abilities:
• 5+ yrs healthcare payer system pricing, contract and benefits configuration experience, preferably on HealthRules, Xcelys, IkaSystems, Facets
• 3+ yrs experience in Medicare/Medicaid reimbursement analysis and configuration directly or indirectly with payer organizations with an understanding of Medicare reimbursement methodologies and payment systems. Experience with Optum EASYGroup a plus.
• 3+ yrs experience analyzing claims data, specific to claims processing guidelines and HIPAA related codes sets
• Demonstrated analytical and problem-solving skills
• Effective written and verbal communication skills
• Experience with Microsoft Office products and PL/SQL Developer for querying and analyzing system data
Minimum Educational Requirements:
• Bachelor's degree
of Daily Tasks:
• Implement the pricing and benefits configuration, maintaining requirements documentation including design documents, business decision logs, meeting minutes, testing scenarios, paper configuration sets, error tracking logs, transition documents and any other tools utilized to configure and maintain the system.
• Analyze customer requirements, including professional and institutional provider contracts and apply your expertise of payment methodologies, to design configuration for optimal claim auto-adjudication and accuracy.
• Participate in discussions and business requirements definition with internal and external customers for requests and projects, ensuring the successful delivery of configuration services
• Provide timely and accurate completion of configuration change requests, maintaining proper documentation and identifying effective control standards of system configuration changes.
• Create, document and execute test cases based on implemented system configuration and customer's expected results.
• Apply your experience in claims processing and claims billing practices to evaluate claims data to design configuration and to problem solve claims processing issues related to possible pricing and reimbursement errors.
• Mentor less experienced team members including but not limited to configuration and pricing expertise, business rules, and business processes
• Troubleshoot system and claim processing errors, determining root cause and corrective actions required
• Participate in project activities across cross-functional teams related to pricing configuration, requirements implementation, defect resolution, and impact reporting
• Use your domain expertise to proactively identify, recommend, and drive process improvements including automation, enhanced process controls, and process redesign, while considering industry best practices and customer expectations
Knowledge, Skills, & Abilities:
• 5+ yrs healthcare payer system pricing, contract and benefits configuration experience, preferably on HealthRules, Xcelys, IkaSystems, Facets
• 3+ yrs experience in Medicare/Medicaid reimbursement analysis and configuration directly or indirectly with payer organizations with an understanding of Medicare reimbursement methodologies and payment systems. Experience with Optum EASYGroup a plus.
• 3+ yrs experience analyzing claims data, specific to claims processing guidelines and HIPAA related codes sets
• Demonstrated analytical and problem-solving skills
• Effective written and verbal communication skills
• Experience with Microsoft Office products and PL/SQL Developer for querying and analyzing system data
Minimum Educational Requirements:
• Bachelor's degree
💡 Quick Summary
Seeking a career-building opportunity? The BPO Supervisor position is now open for candidates interested in the BPO Jobs sector. This role in Uttar Pradesh offers a professional environment and growth potential.
Requirement Snapshot: Candidates should possess basic communication skills, a proactive attitude, and the ability to work in a team. Experience in BPO Jobs is a plus.
