Vacancy expired!
- Resolves non-routine issues escalated from leadership, business, clients, and junior team members
- Participate in projects to support business initiatives and drive increased operational efficiency
- Working with subject matter experts, team leads and supervisors to identify solutions for procedural gap to support business needs
- Responsible for leading discussions with cross-functional teams, to understand, and evaluate processes, procedures (standard operating procedures, job aids, and work instructions)
- Plays a significant part in client implementations and internal integration/migration efforts, as well as change requests, design documentation creation and/or approval
- Participation in requirement sessions and perform testing of applications/databases in all environments
- In addition, this position will be responsible for researching and responding to questions in relation to process, requirements, and testing
- Completes day-to-day project tasks without immediate supervision. Tasks involve a degree of forward planning and anticipation of needs/issues
- The associate will be responsible for collaboration and oral/written communication with internal and external client business operations, IT departments and QA departments to support these requirements
- Act as Subject Matter Expert for the PLEXIS Claims Manager (PCM) claim system and related wrapper processes
- Provide SME support to Claims Systems Analysts and other internal departments, as well as external clients and vendors
- Provide production support research and resolution for claim system related issues
- Analyze existing setups and future system releases for opportunities to continually improve adjudication automation and accuracy, support documentation updating as necessary
- Ability to communicate concepts and insights to business leaders and partners in a relevant and actionable manner
- Partner with technology and analytics teams to develop new data sources for reporting.
- Act as liaison between business and technology to execute project initiatives, and resolve issues
- Responsible for prioritization and execution of assigned tasks and ability to identify needed actions with limited direction
- PLEXIS Claims Manager subject matter expert in system configuration, processing, reporting and issue triage
- Ability to effectively operate within a fast pace, dynamic organization Analyze business and user requirements, and translate into proper system requirement specifications and creation of test plans/use cases to support end to end testing.
- Proficiency in MS Office products, including Access Accomplished in claims lifecycle knowledge, SDLC, requirements analysis, configuration design, claims adjudication framework.
- Excellent written, oral communication, client-based communication skills and interpersonal skills.
- Knowledge of industry standard claims data types (837, 835, 277, 999) and editing rules (ICD, CPT/HCPC, NCCI, MPPR, OPPS, RBRVS, FFS)
- Knowledge in SQL querying
- Knowledge of database management systems (DB2, SQL Server).
- Education: Bachelor s degree in business, healthcare, or computer related field.
- 7+ years of healthcare claims life cycle experience, emphasis in claims system requirements analysis and configuration design.
- Open to remote candidates, should be able to work on a CST or EST schedule.
- Medical Insurance
- Dental Insurance
- Vision Insurance
- 401(k) Plan
- Vacation Package
- Life & Disability Insurance Plans
- Flexible Spending Accounts
Vacancy expired!