Business Consultant- HealthRules Payer

1 month ago

Sacramento, California, United States HealthEdge Software Inc Full time

Overview

Position Overview:

As part of the HealthEdge Professional Services team, theHRPBusiness Consultant is a client-facing role which guides our customers through theirimplementationof our software.This position requires a candidate to perform the responsibilities of a Computer Software/Systems Analyst to include but not limited to creation, redesigning/modification and testing of configured computer software, used to auto-pay healthcare claims.

Responsibilities include requirements gathering, definition, and configuration of the system and workflows for HRP (HealthRulesPayer) customers as necessary. The Business Consulting team drives projects through billable business consulting and advises our customers on optimization of theirHealthRules Payerinstancebased on the analysis of the customer's requirements.

The Consultant will be expected toreview all aspects of animplementationdesign requirementsand undertake system software code changes, quality assurance and testing, documentation ofconfigurationartifacts and occasionally assists with training. Business Consultants also support tier 1 troubleshooting and root cause analysis, along with proof-of-concept configuration to support optimal use of HealthRules Payer.

Your Impact:

  • Serve as a software expert for the customer during their implementation and during SOW projects
  • Responsible for proactively conducting interviews with all stakeholders to elicit detailed functional and system software requirements and managing the requirements throughout the course of the project
  • Assess the current state of the customer's environment
  • Identify and track product gaps
  • Create action item list and issue list
  • Complete business specification stories including acceptance criteria
  • Apply systems analysis techniques and procedures, including consulting with Customer SMEs (system users), to determine software or system functional specifications as pertaining to HRP software
  • Gather and document requirements to design.
  • Based on design requirements, develop/build code related modifications (system configurations) to claims payment computer software, based on user specifications
  • Write HRL (proprietary software application language) statements to program application behavior based on customer business requirements.
  • Design and configure system settings to address the needs of end users, using product specific software code across multiple work streams.
  • Undertaking testing and QA activities to test configuration and functionality
  • Execute manual and automated scripts to carry out functional and regression testing
  • Migrate newly created software protocols for claims payment between customer environments, including promotion to Production environment as part of go-live cutover and testing activities
  • Assist in the preparation and delivery of training materials
  • Work closely to support project members and various project teams
  • Work closely with stakeholders (ie business unit personnel, business experts, other technical staff, vendors, and contractors) to understand and document business and system requirements
  • Responsible for post implementation support as needed including troubleshooting
  • Responsible for ensuring unique customer needs are properly translated into business terms and communicated across all applicable domains
  • Consult with customer to create custom code or enhancement requirements using test-driven development methodology
  • Perform all job functions consistent with HealthEdge policies and procedures, including those which govern handling PHI and PII

What You Bring:

  • 10+ years experience with health plan claims and benefits administration software
  • 3-5 years prior consulting experience in a client facing environment
  • 3-5 years prior experience configuring HealthRules Payer
  • Strong experience with writing the HRL statements and testing
  • Strong business acumen and ability to guide conversations and advise on best practices
  • Strong analytical and problem-solving skills
  • Strong written and verbal communication skills
  • Experience with Jira and Salesforce
  • Job Location: Client site and virtual
  • Travel:Up to 50% travel as needed
  • 4-yearbachelor's degreestrongly desired but can substitute 10+ years of relevant experience

HealthEdge commits to building an environment and culture that supports the diverse representation of our teams. We aspire to have an inclusive workplace. We aspire to be a place where all employees have the opportunity to belong, make an impact and deliver excellent software and services to our customers.

Geographic Responsibility: While HealthEdge is located in Burlington, MA you may live anywhere in the U.S.

Type of Employment: Full-time, permanent

Travel%: Up to 50%

Budget/Revenue Responsibility: None

Work Environment: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job:

  • The employee is occasionally required to move around the office. Specific vision abilities required by this job include close vision, color vision, peripheral vision, depth perception, and ability to adjust focus.
  • Work across multiple time zones in a hybrid or remote work environment.
  • Long periods of time sitting and/or standing in front of a computer using video technology.
  • May require travel dependent on company needs.

The above statements are intended to describe the general nature and level of the job being performed by the individual(s) assigned to this position. They are not intended to be an exhaustive list of all duties, responsibilities, and skills required. HealthEdge reserves the right to modify, add, or remove duties and to assign other duties as necessary. In addition, reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position in compliance with the Americans with Disabilities Act of 1990. Candidates may be required to go through a pre-employment criminal background check.

HealthEdge is an equal opportunity employer. We are committed to workforce diversity and actively encourage all qualified persons to seek employment with us, including, but not limited to, racial and ethnic minorities, women, veterans and persons with disabilities.

Job Locations US-Remote

ID

Category Professional Services

Position Type Full-Time

HealthEdge provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

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