HealthRules Payor Analyst

Overview

Remote
Accepts corp to corp applications
Contract - 11

Skills

SQL
HealthRules Payor
HealthRules Designer

Job Details

Job title:HealthRules Payor Analyst
Location:Remote
mandatory Skills: HRP (HealthRules Payor), Health Plan,SQL,


Responsibilities: As an HRP Technical Analyst, you will be responsible for delivering technical and business solutions within the healthcare payor domain. The ideal candidate is highly organized, detail-oriented, and possesses strong analytical and problem-solving skills. You should be comfortable managing multiple tasks in a fast-paced, deadline-driven environment and capable of working both independently and collaboratively. Excellent verbal and written communication skills are essential, along with the ability to present information clearly to managers and clients.

Key Responsibilities:

  • Understand benefit terminologies such as Copay, Coinsurance, Deductible, Limits, Pre-authorization, etc.
  • Possess knowledge of various lines of business, including Commercial, Medicare, Medicaid, ASO, HIX, and Fully Insured.
  • Demonstrate excellent design and technical skills with Oracle PL/SQL and/or SQL Server development (including stored procedures, views, packages, functions, triggers).
  • Gather business requirements and deliver analytics-based solutions using structured and unstructured business data to achieve measurable business outcomes for clients.
  • Have good knowledge of US healthcare and payor business functions.
  • Perform configuration of products, service categories, value lists, BPC, and benefit plans.
  • Configure network, supplier contracts, fee components, and fee schedules.
  • Conduct due diligence in understanding the client's current system and create benefit plans based on benefit plan documents.
  • Certification as a HealthEdge (HE) Business Analyst is a plus.

Mandatory Technical Skills:

  • Hands-on experience with HRP (HealthRules Payor).
  • Strong healthcare (Health Plan) domain knowledge, including Member, Provider, Claims, and Finance modules.
  • Expertise in Oracle and/or SQL Server development and programming.
  • Experience with HealthRules Payor, HealthRules Designer, and HealthRules Manager.
  • Benefit plan configuration and supplier contract configuration expertise.
  • Excellent knowledge of SQL.
Disclaimer: E-Solutions Inc. provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, gender, sexual orientation, gender identity or expression, national origin, age, disability, genetic information, marital status, amnesty, or status as a covered veteran in accordance with applicable federal, state and local laws. We especially invite women, minorities, veterans, and individuals with disabilities to apply. EEO/AA/M/F/Vet/Disability

HealthRules Payor Analyst1SQL,HealthRules Payor,HealthRules DesignerN/AC2CUnited States
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