Healthcare Claims Analyst
4 weeks ago
Position type: Contract
Duration: 6 Months
Location: Atlanta, GA (Hybrid)
25% travel needed
As a Healthcare Claims Analyst, you will be:
- Configure Claims payment system to ensure accurate and consolidated reimbursements to payees (provider, member and other) within a defined payment cycle.
- Knowledge in the following business processes
- Reimbursement of medical and other claims
- EFT set up
- Data exchange between various entities leading to the final payment to payees.
Required Skills:
Configure accounts receivable processing tasks including setting up accounts receivable, developing reports specifications to on accounts receivable. Assess client AR business operations and configure or develop new processes for configuring the financial system. Knowledge in the following business processes.
- Experience in Provider Recoupment in a Payer setup
- Manage Recoveries
- Manage AR funds
Configure accounts payable processing tasks including set up accounts payable, developing reports specifications for accounts payable. Discuss with client to understand their accounts payable operations and configure financial system according to the client processes. Knowledge in the following business processes.
- Manage contractor payments
- Manage AP disbursement
- Familiar with 1099 Process
- Fiscal Management
- Budget Management
- Manage Funds
Compare current reports (accounts receivable, accounts payable, cash receipts and other payment related etc.) with client specific reports to identify the gaps.
- Must have a prior experience in implementing/maintenance of commercial payer claims solution and/or Medicare/Medicaid system
- Must have good experience with claims processing concepts, along with the provider, member enrolment and care management concepts.
- Must have good experience in Reference code/data sets required in Claims adjudication including not limited to CPT, CDT, HCPCS, ICDs.
- Must have prior experience or understanding in configuring benefits or programs in claims system across various sub-systems.
- Must be able to work with the clients to create/gather requirements and document them according to standards.
- Must adhere to (or if needed, define) the processes for requirement solicitation, documentation and hand off.
- Should work closely with the IT development team to elucidate the requirements, enable constructive discussions / brainstorming sessions to implement the best in class solution.
- Should have basic understanding concepts like web services, relational databases etc.,
- Should be able to run queries and perform basic system analysis, RCA etc.,
- Should be able to create mapping documents for the various interfaces and include business rules, transformation and DB mapping.
- Should work closely with the client and development team during the stages of development, and conduct demos at completion of milestone, track and close feedback from such demos
- Must have excellent written and spoken communication skills. Should be able to multitask between internal team and clients based on priority tasks
The ideal candidate will have:
- Minimum of 12-15 years of experience in IT industry.
- Capability to think out-of-the-box to create new solutions as needed.
- Prior experience as an IT QA or Developer in a healthcare system would be helpful though not mandatory.
- Ability to validate Test scenarios and test plans, test data.
- Should be able to Review requirements, documentation and create Requirements Traceability matrix (RTM)
- Should have excellent communication (written and spoken ) skills to engage with different stake holders like QA/dev team, clients, end users of Clients and Business Units.
- Ability to assess current functionality available in a product vis a vis market trends, regulatory requirements to be implemented in future version of the product.
- Ability to drive and share the requirements with Technical and Architects regarding product features to be implemented
Optional tools usage:
- MS Visio to define the different views like System, technical, functional and role based view.
- Awareness defect tracking and version control tools like Jira, TFM, DevOps, Azure
- DB client to write data queries to validate data updated in the database table.
Qualified candidates should APPLY NOW for immediate consideration Please hit APPLY to provide the required information, and we will be back in touch as soon as possible.
Thank you
Kiran Vajrala
Manager
PAY RANGE AND BENEFITS:
Pay Range*: USD 96,500 USD 113,000 Per Year
*Pay range offered to a successful candidate will be based on several factors, including the candidate's education, work experience, work location, specific job duties, certifications, etc.
Benefits: Innova Solutions offers benefits( based on eligibility) that include the following: Medical & pharmacy coverage, Dental/vision insurance, 401(k), Health saving account (HSA) and Flexible spending account (FSA), Life Insurance, Pet Insurance, Short term and Long term Disability, Accident & Critical illness coverage, Pre-paid legal & ID theft protection, Sick time, and other types of paid leaves (as required by law), Employee Assistance Program (EAP).
ABOUT INNOVA SOLUTIONS: Founded in 1998 and headquartered in Atlanta, Georgia, Innova Solutions employs approximately 50,000 professionals worldwide and reports an annual revenue approaching $3 Billion. Through our global delivery centers across North America, Asia, and Europe, we deliver strategic technology and business transformation solutions to our clients, enabling them to operate as leaders within their fields.
Recent Recognitions:
- One of Largest IT Consulting Staffing firms in the USA Recognized as #4 by Staffing Industry Analysts (SIA 2022)
- ClearlyRated® Client Diamond Award Winner (2020)
- One of the Largest Certified MBE Companies in the NMSDC Network (2022)
- Advanced Tier Services partner with AWS and Gold with MS
Innova Solutions is an Equal Opportunity Employer and prohibits any kind of unlawful discrimination and harassment. Innova Solutions is committed to the principle of equal employment opportunity for all employees and to providing employees with a work environment free of discrimination and harassment on the basis of race, color, religion or belief, national origin, citizenship, social or ethnic origin, sex, age, physical or mental disability, veteran status, marital status, domestic partner status, sexual orientation, or any other status protected by the statutes, rules, and regulations in the locations where it operates. If you are an individual with a disability and need a reasonable accommodation to assist with your job search or application for employment, please contact us at hr@innovasolutions.com or (770) 493-5588. Please indicate the specifics of the assistance needed. Innova Solutions encourages all interested and qualified candidates to apply for employment opportunities. Innova Solutions (HireGenics/Volt) does not discriminate against applicants based on citizenship status, immigration status, or national origin, in accordance with 8 U.S.C. § 1324b.
The company will consider for employment qualified applicants with arrest and conviction records in a manner that complies with the San Francisco Fair Chance Ordinance, the Los Angeles Fair Chance Initiative for Hiring Ordinance, and other applicable laws.
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