Healthcare Rules Payer (HRP) Configuration Lead
Remote
As an HRP 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. Responsibilities: - Understands Healthcare Payor business functions and IT systems Understanding of US Healthcare Payor work-streams including Claims, Network and Pricing, Provider Management, Medical Management, Premium Billing and Payment, Member Enrollments, Benefits Management, HIPAA X12 transactions 837I/P/D,834, 270/271, 835 Well versed with various lines of business - Medicaid, Medicare, commercial etc. Healthcare industry standards and codes usage - ICD10, HCPCS, CPT, Revenue Codes, DRG, APC and NDC Core Administrative Processing Systems (HealthRules, Facets, and QNXT, etc.) HealthRules Configuration: Set up of Benefit Plan, Network and Supplier Contracts (Pricing), Providers, Enrollment, Premium, and Account, sub-accounts, etc. 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, QNTX, etc.) to HealthRule 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
Experience: - 12+ Years
Educational Qualifications: - Bachelor s degree in computer science, information technology or a similarly relevant field is highly preferred.
Skills: - Mandatory Technical skills HealthRules Payer, HealthRules Language, HealthEdge Good to have skills: - Agile, SAFe
