Job Title: Medical Claims SME
Job ID: 2023-12067
Job Location: Whippany, NJ (2-3x/week hybrid)
# Positions: 1
Employment Type: W2
Candidate Constraints:
- Duration: Long Term
- # of Layers: 0
- Work Eligibility: All Work Authorizations are Permitted – No Visa Transfers
Key Technology: coding principles, benefits, pricing, third-party liability, billing, payment, adjustments, reconciliation, rebilling, refunds, denials
Job Responsibilities:
- Perform current claims process analysis, risk analysis, impact analysis
- Collaborate with technical and business teams to stitch together the current state of the Claims system and processes
- Advise best practices around Claims processing and data governance
- Design data and processes to meet regulatory requirements and business needs
- Provide claims domain knowledge expertise in refining the existing Claims processes
Skills and Experience Required:
Technical Skills:
- Medical Claims Professional who has Subject matter expertise in data requirements and processing for the analysis and resolution of claims, including coding principles, benefits, pricing, third-party liability, billing, payment, adjustments, reconciliation, rebilling, refunds, denials.
- Demonstrate working understanding of claims processing systems and working knowledge of the health care industry.
- Business Systems Analysis experience in claim processing and structures.
- Meet with business areas to gather process and integration requirements to ensure claims are processed correctly to prevent the company from liabilities.
- Experience with design of claims business process and systems
Non-technical Skills:
- Quick learner
- Detail oriented
- Must have analytical capacity to solve business problems
- Excellent communication skills, both written and verbal
- Ability to collaborate with different teams and able to execute projects in a timely manner
Desired Skills:
- Expert knowledge of Medical Claims Processing
- Experience with FACETS Claims Processing
#J-18808-Ljbffr
