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About the Role
- Must have very good understanding of the healthcare payer space with a minimum experience of 10 years in the domain.
- Must have a prior experience in implementing/maintenance of commercial payer claims solution and/or Medicare/Medicaid system
- Must have good experience with claims processing concepts, along with the provider, member enrolment and care management concepts.
- Must have good experience in Reference code/data sets required in Claims adjudication including not limited to CPT, CDT, HCPCS, ICDs.
- Must have prior experience or understanding in configuring benefits or programs in claims system across various sub-systems.
- Must be able to work with the clients to create/gather requirements and document them according to standards.
- Must adhere to (or if needed, define) the processes for requirement solicitation, documentation and hand off.
- Should work closely with the IT developm...
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