Overview
Skills
Job Details
We have two roles- Pricing Analyst and Configuration Analyst.
Locations- Jefferson, MO & Tampa, FL
Role# 1 Pricing Analyst
Job Description
The Pricing Analyst is responsible for designing, configuring, testing, implementation and maintenance of HealthRules Payor Pricing, claims and/or benefit configuration, according to business requirements, to support accurate and efficient claims processing and data reporting to meet the needs of the Company. Investigate and resolve configuration-related provider, member and claim processing issues and assist other departments in understanding HealthRules Payor Pricing configuration. Lead and/or be part of complex HealthRules Payor Pricing Implementation and/or configuration projects. This position must possess strong analytical skills, with the ability to perform complex business rules set up in a fast-paced environment. The Configuration Analyst serves as a subject matter expert (SME) on customer projects that require configuration modifications within the claims processing system
Responsibilities:
Design, Develop, Configure and Test HealthRules Payor Pricing configuration, contracts, products, and policies to Implement HealthRules Payor Pricing.
Analyze, configure, test, implement and maintain HealthRules Payor Pricing to support changes in contracts, products, legislation, policies, and procedures, ensuring timely maintenance and updates of configuration
Test, implement and train on new HealthRules Payor PricingPricing and third party product releases, modules and updates.
Assist in the development of test scenarios for changes and/or projects. Manage the timely resolution of open testing bugs and issues. Develop and monitor postproduction audit reports to ensure the intent of change and/or project requirements is being met.
Develop and maintain configuration documentation and communicate changes, as appropriate.
Work with Business Users, Technical team and QA to create detailed functional requirements that support and align to business requirements and testing scenarios.
Research and respond to service requests in a prompt and timely manner and update or build configuration in HealthRules Payor Pricing as needed.
Recommend and draft new and updated procedures to maximize the use of HealthRules Payor Pricing and other third-party products to improve efficiency.
Inform leader and peers of changes that will impact Company s Medicare business. Research and recommend methods to improve or implement necessary changes in a prompt and efficient manner.
Experience/Skills:
Minimum of 3 years of experience in payer operations, claim processing, and experience deploying HealthRules Payor Pricing software.
Minimum of 3 years of hands-on configuration experience in HealthEdge's HealthRules software.
Must possess working knowledge of Medicare operations, system development and testing.
Expertise in using Microsoft Office; including Excel, Word, Access, Power Point, and Visio.
Experience working within a matrix organization. Excellent oral and written communication skills and the ability to interface with all levels of customer organization
Collaboration, leadership, organizational, writing, interpersonal and communication skills.
Preferred Requirement:
Previous experience with CMS and Medicare Operations.
Knowledge of or experience with ClaimXten, Axiom TranSend, and Axiom TransShuttle
Education qualification:
Bachelor s degree in business or health care preferred; demonstrated work experience may be considered in lieu of degree.
Mandatory Skills: Medicare.
Role# 2 Configuration Analyst- Benefits
Job Description
The Configuration Analyst is responsible for designing, configuring, testing, implementation and maintenance of HealthRules Payor pricing, claims and/or benefit configuration, according to business requirements, to support accurate and efficient claims processing and data reporting to meet the needs of the Company. Investigate and resolve configuration-related provider, member and claim processing issues and assist other departments in understanding HealthRules Payor configuration. Lead and/or be part of complex HealthRules Payor Implementation and/or configuration projects. This position must possess strong analytical skills, with the ability to perform complex business rules set up in a fast-paced environment. The Configuration Analyst serves as a subject matter expert (SME) on customer projects that require configuration modifications within the claims processing system.
Responsibilities:
Design, Develop, Configure and Test HealthRules Payor configuration, contracts, products, and policies to Implement HealthRules Payor.
Analyze, configure, test, implement and maintain HealthRules Payor to support changes in contracts, products, legislation, policies, and procedures, ensuring timely maintenance and updates of configuration.
Test, implement and train on new HealthRules Payor and third party product releases, modules and updates.
Assist in the development of test scenarios for changes and/or projects. Manage the timely resolution of open testing bugs and issues. Develop and monitor postproduction audit reports to ensure the intent of change and/or project requirements is being met.
Develop and maintain configuration documentation and communicate changes, as appropriate.
Work with Business Users, Technical team and QA to create detailed functional requirements that support and align to business requirements and testing scenarios.
Research and respond to service requests in a prompt and timely manner and update or build configuration in HealthRules Payor as needed.
Recommend and draft new and updated procedures to maximize the use of HealthRules Payor and other third-party products to improve efficiency.
Inform leader and peers of changes that will impact Company s Medicare business. Research and recommend methods to improve or implement necessary changes in a prompt and efficient manner.
Experience/Skills:
Minimum of 3 years of experience in payer operations, claim processing, and experience deploying HealthRules Payor software.
Minimum of 3 years of hands-on configuration experience in HealthEdge's HealthRules software.
Must possess working knowledge of Medicare operations, system development and testing.
Expertise in using Microsoft Office; including Excel, Word, Access, Power Point, and Visio.
Experience working within a matrix organization. Excellent oral and written communication skills and the ability to interface with all levels of customer organization
Collaboration, leadership, organizational, writing, interpersonal and communication skills.
Preferred Skills:
Previous experience with CMS and Medicare Operations.
Knowledge of or experience with ClaimXten, Axiom TranSend, and Axiom TransShuttle.
Education:
Bachelor s degree in business or health care preferred; demonstrated work experience may be considered in lieu of degree.
Mandatory Skills: Medicare.