• Us Citizen

• Green Card

• EAD (OPT/CPT/GC/H4)

• H1B Work Permit

• Corp-Corp

• Consulting/Contract

• UG :- - Not Required

• PG :- - Not Required

• No of position :- ( 1 )

• Post :- 2nd Sep 2021

•             Develop and maintain an understanding of current HealthRules Payor configuration, contracts, products, and policies.

•             Provide production support between trading partners, software vendors and/or their clearinghouses

•             Resolve any claim processing issues that arise within SNG/SFG, Foresight, Extol, PowerMHS/AS400 or HealthRules adjudication systems

•             Validate Foresight claim edits as needed

•             Execute all new trading partner setup including transmission method, mapping, translation, onboarding, and testing

•             Analyze, configure, test, implement and maintain HealthRules Payor to support changes in contracts, products, legislation, and client policies and procedures, ensuring timely maintenance and updates of configuration.

•             Test, implement and train on new HealthRules Payor and third party product releases, modules and updates.

•             Assist in the development of test scenarios for changes and/or projects.

•             Manage the timely resolution of open testing bugs and issues.

•             Develop and monitor post production audit reports to ensure the intent of change and/or project requirements is being met.

•             Develop and maintain configuration documentation and communicate changes, as appropriate.

•             Work with Technical Business Analyst, UAT and QA to create detailed functional requirements that support and align to business requirements and testing scenarios.

•             Research and respond to service requests in a prompt and timely manner and update or build configuration in HealthRules Payor as needed.

•             Recommend and draft new and updated procedures to maximize the use of HealthRules Payor and other third-party products to improve efficiency.

•             Develop and maintain good working relationships with the staff of other departments including Provider Relations & Contracting, Healthcare Economics, Provider Assistance Center, Government Relations, Product, and Coverage Policy.

•             Inform leader and peers of changes that will impact the client.

•             Research and recommend methods to improve or implement necessary changes in a prompt and efficient manner.

You'll Be Successful If:

•             Healthrules Payor implementation experience REQUIRED

•             Five years of EDI analysis experience or a combination of claims processing, healthcare system operations, data analytics and configuration.

•             Must possess working knowledge of managed care operations, system development and testing.

•             Microsoft Office proficiency.

•             Ability to build and maintain relationships across the enterprise.

•             Previous experience with CMS, Client or payer reimbursement methodologies and /or payment policies.