The Payment Accuracy Advisor (PAA) is responsible for understanding their assigned clients claim systems and payment policies so they may document requirements for implementing services and rule engine components either during the initial and/or subsequent phase of implementation. They are also responsible for supporting their clients during maintenance periods which may require researching issues, analyzing software behavior and remediating defects.
The Payment Accuracy Advisor must be an active consultative client facing participant within the assigned team structure to ensure quality client deliveries within targeted timeframes based upon work effort and allocation.
o Customer' s Business
• Understands payor environments and claims management
• High level understanding of different customer segments (national, strategic and/or specialized business)
• High level understanding of claim architecture, infrastructure, and multiple platforms
• Discusses customer issues (pains and trends) confidently with customers
• Understands medical terminology, healthcare industry terminology and medical coding terminology
• Must be able to articulate the clinical value of products and services provided to clients
• Delivers presentations effectively to the customer
• Able to understand and articulate ClaimsXten rules development
• Conducts customer meetings/trainings efficiently and effectively
o Software Tools
• High-level proficiency in the following software:
IV. Working Conditions:
General Office conditions
Travel 10% to 15%
? Minimum Job Qualifications:
• Bachelor' s Degree in computer science, healthcare related field, or equivalent business experience
II. Business Experience
• 3+years of experience in health care combining first hand payor and consulting experience
• Medical claims experience within payor environment ideal.
• SDLC exposure needed.
III. Critical Skills
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