| Urgent requirement for the position of Health Edge Operations Specialist Remote at Remote, Remote, USA |
| Email: [email protected] |
| From: Ashwani, Gtech [email protected] Reply to: [email protected] Hi, Currently, I am recruiting candidates for one of my requirement as mentioned below. If you have a matching profile, please send me the updated resume along with contact details at the earliest. Job Title Health Edge Operations Specialist Project Location Remote Duration 6 Months Contract Phone Interview Followed By Skype Skills Required and Job Description: Job Description; Create new and modify existing Claims Pricing configurations. Configures and maintains the business rules within the Claims Processing ecosystem. Configures the Health Rules (benefits and Package pricing) software from development into the testing and deploying to the production environment. Recommends and implements benefit and pricing setup based on knowledge of system configuration capabilities and information obtained from business clients. Independently evaluates business procedures and problems. Hands-on working knowledge in resolving production issues related to Benefit configurations. Identifies research and resolves inaccuracies and inconsistencies in the business rules as they impact claims payment and other upstream and downstream transactions. Resolve configuration defects and perform testing to validate the updates are working as expected. Participates in business requirements gathering sessions to identify specifications and solutions. Evaluate and recommend configuration solutions to Business and IT leadership. Identifies and assesses potential problems and performs and implements system enhancements, modifications, and upgrades. Provides application and technical support for the health Rules software as well as troubleshooting for end users. Works with IT to define business and IT systems requirements. Identifies and assesses potential problems and performs and implements system enhancements, modifications, and upgrades. Mentors and guides business users with the design and impact of configuration changes. Creates test case scenarios for application and configuration testing and ensures appropriate testing has been completed before the changes are deployed into the production environment. Designs, develops, and maintains user system documentation. Evaluates and monitor coded data elements. Assists users in understanding business system functions. Skills Must have 4+ years of HealthCare operations or Healthcare claims processing experience. Proficiency in Healthcare and Health Plan terminology, and medical coding (e.g., CPT, HCPCS, ICD9 & ICD10 CDT, Revenue, DRG, and other relevant medical and industry-standard codes). Deep understanding of benefit plans, benefits association (package, coverage, component, and detail), benefit coding (Benefit keywords and linkage associations), Claims to process, and workflows for multiple Lines of Business including FEP, and BCBS Association mandates. Experience in SQL and other relevant tools and technology used for Benefit configuration updates. Working knowledge ofMS Azure DevOps. Education - Bachelor's degree in Business Administration, Management Information Systems, Computer Science, or equivalent work experience. In lieu of a degree, a minimum of 3-4 years of proven configuration experience, preferably on Facets, Health Rules, Diamond, Amisys Advance, or a similar payer system. Nice to have Experience inAgile methodology and framework. |
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| Sat Nov 12 00:34:00 UTC 2022 |