Lead HealthRules Implementation Consultant

Lead HealthRules Implementation Consultant

Job Summary:

Client is looking for a HealthRules Implementation Lead to spearhead the end-to-end deployment of HealthEdge s HealthRules platform (HealthRules Payor and/or HealthRules CareManager). The ideal candidate will be responsible for overseeing implementation strategy, client coordination, system configuration, integration planning, and go-live support. This role is critical to ensuring a smooth and successful implementation that meets both business and regulatory requirements.

Required Qualifications:

• 5+ years of experience in leading HealthRules implementations (HealthRules Payor or CareManager).
• Deep understanding of claims processing, provider/pricing configuration, member eligibility, and benefits administration within HealthRules.
• Prior experience with healthcare payor systems, especially in managed care or Medicaid/Medicare environments.
• Proven experience with project leadership, stakeholder engagement, and vendor coordination.
• Strong knowledge of EDI transactions (e.g., 837, 835, 270/271).
• Proficient in system integration, data migration, and testing strategies.
• Excellent verbal and written communication skills.
• Experience with Agile/Scrum methodologies is a plus.

Preferred Skills:

• Certification in HealthRules Payor or related HealthEdge platform.
• Experience with other healthcare technologies like Facets, QNXT, TriZetto, etc.
• Background in clinical data integration and care management.

Education:

• Bachelor s degree in Computer Science, Healthcare Administration, Information Technology, or a related field.
• Master s degree or MBA preferred.

Travel Requirement:

• Occasional travel may be required depending on client and project location.