CitiusTech · 23 hours ago
Sr Healthcare Consultant
United States
Full-time
Remote
Senior Level, Lead/Staff
12+ years exp
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Hiring Manager
Praveena Praveen
Insider Connection @CitiusTech
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Responsibilities
Understand Healthcare Payor business functions and IT systems
Understanding of US Healthcare Payor work-streams including Claims, Network and Pricing, Provider Management, Medical Management, Premium Billing and Payment, Member Enrollments, Benefits Management, HIPAA X12 transactions 837I/P/D,834, 270/271, 835
Well versed with various lines of business - Medicaid, Medicare, commercial etc.
Healthcare industry standards and codes usage - ICD10, HCPCS, CPT, Revenue Codes, DRG, APC and NDC
Core Administrative Processing Systems (HealthRules, Facets, and QNXT, etc.)
HealthRules Configuration: Set up of Benefit Plan, Network and Supplier Contracts (Pricing), Providers, Enrollment, Premium, and Account, sub-accounts, etc. Interacting with customers, internal stakeholders and other third-party vendors for requirements gathering, architecture and design discussions, development, testing and other activities
Implement HealthRules as claims adjudication system and integration of HealthRules with existing application ecosystem
Responsible for architecting, designing and deployment of HealthEdge HRP components in implementing a Claim administration system
Understand HealthRules API and Connector services and can integrate HealthRules with required applications
Support / guide data profiling and data migration from other claims systems (Facets, Amisys, QNTX, etc.) to HealthRule system
Documentation of project deliverables and versioning
Mentor and guide team on technology, frameworks, processes and ensure quality of deliverables
Support testing and deployment of HRP solutions
Architect, design, code, test and document interfaces of moderate-to-high complexity as per the requirement specifications
Mentor and guide team on technology, frameworks, processes and ensure quality of deliverables.
Support testing and deployment of HRP solutions
Qualification
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Required
12 + Years of experience
Understanding of US Healthcare Payor work-streams including Claims, Network and Pricing, Provider Management, Medical Management, Premium Billing and Payment, Member Enrollments, Benefits Management, HIPAA X12 transactions 837I/P/D,834, 270/271, 835
Well versed with various lines of business - Medicaid, Medicare, commercial etc.
Healthcare industry standards and codes usage - ICD10, HCPCS, CPT, Revenue Codes, DRG, APC and NDC
Core Administrative Processing Systems (HealthRules, Facets, and QNXT, etc.)
HealthRules Configuration: Set up of Benefit Plan, Network and Supplier Contracts (Pricing), Providers, Enrollment, Premium, and Account, sub-accounts, etc.
Interacting with customers, internal stakeholders and other third-party vendors for requirements gathering, architecture and design discussions, development, testing and other activities
Implement HealthRules as claims adjudication system and integration of HealthRules with existing application ecosystem
Responsible for architecting, designing and deployment of HealthEdge HRP components in implementing a Claim administration system
Understand HealthRules API and Connector services and can integrate HealthRules with required applications
Support / guide data profiling and data migration from other claims systems (Facets, Amisys, QNTX, etc.) to HealthRule system
Documentation of project deliverables and versioning
Mentor and guide team on technology, frameworks, processes and ensure quality of deliverables
Support testing and deployment of HRP solutions
Architect, design, code, test and document interfaces of moderate-to-high complexity as per the requirement specifications
Preferred
Bachelor’s degree in computer science, information technology or a similarly relevant field is highly preferred.
Good to have skills: - Agile, SAFe
Company
CitiusTech
Major provider of technology services and solutions to healthcare technology companies, providers, payers and life sciences organizations
5001-10000 employees
H1B Sponsorship
CitiusTech has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2023 (359)
2022 (385)
2021 (437)
2020 (425)
Funding
Current Stage
Late StageTotal Funding
unknownKey Investors
Bain Capital Private EquityGeneral Atlantic
2022-10-20Private Equity
2019-07-12Acquired
2014-03-20Private Equity
Leadership Team
Rajan Kohli
CEO
Sudhir Kesavan
Chief Operating Officer
Recent News
2024-12-11
2024-12-11
Business Wire India
2024-12-09
Company data provided by crunchbase
