Domain SME

Domain Competencies (APPS)-Bus. Process-Healthcare-Bus. Process-Healthcare. Healthcare Payor Domain

Required Skills
Extensive experience (10+ years) working in the Payor domain within the healthcare industry, with a deep understanding of Payor operations, processes, and technologies.
Strong knowledge of healthcare regulations, compliance requirements, and industry standards related to Payor operations (e.g., HIPAA, HITECH, CMS regulations).
Proven track record of providing strategic guidance, advisory services, and thought leadership in the Payor domain, including business strategy development, process improvement, and technology evaluation.
Excellent communication and interpersonal skills, with the ability to effectively interact with stakeholders at all levels, including executives, clients, and cross-functional teams.
Strong analytical and problem-solving abilities, with the capacity to analyze complex issues, evaluate alternatives, and recommend innovative solutions.
Demonstrated leadership capabilities, with the ability to influence and inspire others, build consensus, and drive change within organizations.

Responsibilities
As a Payor Domain SME, you will be responsible for providing expert guidance, insights, and thought leadership in the Payor domain, particularly within the healthcare industry. You will play a pivotal role in advising on business strategies, industry trends, regulatory requirements, and technology solutions related to Payor operations, including claims processing, member enrollment, provider network management, and revenue cycle management.

Serve as the primary point of contact and subject matter expert for all matters related to Payor operations within the healthcare industry. Stay abreast of industry trends, emerging technologies, regulatory changes, and best practices.
Provide strategic guidance and advisory services to internal stakeholders, including executives, product managers, business analysts, and development teams, on payer-related initiatives, opportunities, and challenges.
Collaborate with stakeholders to gather, analyze, and document business requirements for payer-related projects and initiatives. Translate business needs into actionable recommendations and solutions.
Stay informed about healthcare regulations, compliance standards, and industry mandates affecting Payor operations, such as HIPAA, HITECH, CMS regulations, and state-specific requirements. Ensure adherence to regulatory requirements in all payer-related activities.
Evaluate and assess technology solutions, platforms, and vendors in the Payor space, including claims processing systems, enrollment platforms, provider network management tools, and revenue cycle management software. Provide recommendations for selection and implementation based on business needs and industry best practices.
Identify opportunities for process optimization, automation, and efficiency gains in Payor operations. Collaborate with stakeholders to streamline workflows, reduce administrative burdens, and enhance the overall effectiveness of payer-related processes.
Share expertise, insights, and best practices with internal teams through training sessions, workshops, and knowledge sharing forums. Mentor junior team members and contribute to the professional development of the organization.
Engage with clients, partners, and industry stakeholders to understand their needs, challenges, and priorities in the Payor domain. Provide consultative support, thought leadership, and innovative solutions to address client requirements and drive business growth.