HealthRules Configuration Lead

Required skills:At least 3 years of experience in configuration of Health Rules Payor benefit configuration. At least 3 years of experience in configuration of Health Rules Payor referral category configuration.Expert knowledge of HR Payer table structure Ability to create SQL queries of HR Payer tables

Hi Professionals, Title:Technical Lead II QICLink Configuration Location: Remote JD: Lead QICLink benefit configuration for US healthcare applications, working in an Agile environment to design, build, and implement benefit plans aligned with business requirements. Mandatory Skills Strong QICLink Configuration experience Expertise in Benefit Plan Configuration (Products & Benefits) Knowledge of Benefit Entities (Coverage, Copay, Coinsurance, Deductible, Limits, Pre-auth) Understanding

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 systemMust 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, IC

Responsibilities 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