Health Claims Configuration on Claims Payment System

Health Claims Configuration on Claims Payment System

 

  • Ability to partner & collaborate with associates, managers, directors and senior leadership
  • Advanced knowledge of core processing systems in relation to configuration set-up
  • Advanced problem solving, critical thinking, and process analysis skills to lead teams responsible for client configuration
  • Collaborate with stakeholders to gather business requirements for system configurations and set up
  • Demonstrated proficiency in processing health care claims and to understanding of claim life cycle
  • Ensure changes in provider contracts are reflected in the claims payment system
  • Experience working with government agencies such as CMS, HHS, Medicare, Medicaid, State etc. along with interpreting agency and contract requirements
  • Experience working with provider data with a focus on ensuring accuracy
  • Identify and implement opportunities to automate processes to increase effectiveness and efficiency
  • Knowledge of CPT, ICD-9/ICD-10, HCPCS, Revenue Codes and pricing methodologies
  • Knowledge of health plan benefits, fee schedules and configuration
  • Minimum of 5-8 years Health Care industry knowledge and operations (example: claims processing, enrollment, provider file maintenance) with ability to interpret and document business requirements
  • Oversee the claims configuration and pricing/benefits set up within the claims payment system ensuring accurate reflection of provider contracts and claims payments
  • Oversee the evaluation and analysis of upcoming implementations and ensure successful and smooth transition into claims systems and processes
  • Strong computer skills with proficiency in MS Word, Excel, Outlook, and Access, and Visio
  • Strong process improvement, implementation and team development skills
  • Subject matter expertise to produce innovative solutions, and advance understanding of configuration best practices
  • Timely and accurate configurations and pricing/benefits set up for new business implementations
  • Understanding of healthcare industry, including competitors, the regulatory environment, and industry trends
  • Working knowledge of health plan compliance including government programs such as Medicare, Medicaid and FFM plans
  • Experience on Claims Systems – Plexis, HealthEdge, Trizetto-FACETS, DST etc.
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425 Washington Blvd., Jersey City,
New Jersey 07302, USA

Phone: +1 201.258.4704 / 201.258.4704
Fax: +1 201.604.3480