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Company

CitiusTech · 10 hours ago

HRP Pricing Configuration Lead

United States

Full-time

Remote

Senior Level, Lead/Staff

10+ years exp

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AnalyticsArtificial Intelligence (AI)

H1B Sponsor Likely

Hiring Manager

Disha Jain, AIRS PRC, CDR

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Responsibilities

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, QNXT, etc.) to HealthRules 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

Find out how your skills align with this job's requirements. If anything seems off, you can easily click on the tags to select or unselect skills to reflect your actual expertise.

Healthcare Payor functionsUS healthcare knowledgeClaims adjudicationHealthRules configurationMedicare EligibilityHIPAA X12 transactionsHealthcare industry standardsCore Administrative Processing SystemsHealthRules DesignerHealthRules ManagerContract PricingProvider ManagementNetwork Set-upProvider Pricing ContractingMedical ManagementPremium BillingMember EnrollmentsBenefits Management

Required

10+ Years

Healthcare Payor business functions and IT systems

Good knowledge of US health care and payor business functions

Understanding of US Healthcare Payor work-streams including Claims flow, Claim Adjudication, Provider Management including Network Set-up, Provider Pricing Contracting Rules, Medical Management, Premium Billing and Payments, Member Enrollments, Benefits Management

Strong knowledge on Medicare Eligibility and Set-up in HRP, HIPAA X12 transactions 837I/P/D, 834, 270/271, 835

Well versed with various lines of business – Commercial, Medicare, Medicaid, ASO, HIX and Fully Insured etc.

Healthcare industry standards and codes usage – ICD-10, HCPCS, CPT, DX, POS, Bill Type, Revenue Codes, DRG Pricing, APC Pricing and NDC etc.

Knowledge on any of the Core Administrative Processing Systems (HealthRules, Facets, and QNXT, etc.)

HealthRules Benefits Configuration: Set up Benefit Plans using wizards and BP templates for plan creation

HealthRules Supplier Contracts configuration: Good knowledge on Provider Networks and Supplier Contracts (Confinement Rate, Fee Schedule, Fee Component, Bundled Payment, Capitation), Providers (Supplier & Practitioner), Enrollment, Premium, Account, sub-accounts, etc.

Hands-on HealthRules (HealthRules Designer & HealthRules Manager) configuration experience; Contract Pricing

Highly organized and detail-oriented

Strong analytical, problem solving, and prioritization skills

Ability to handle multiple tasks in a fast-paced, deadline-driven environment, both independently and as part of a team

Excellent verbal and written communication and interpersonal skills

Ability to effectively present information and respond to questions from groups of managers and clients

Preferred

Bachelor’s degree in computer science, information technology or a similarly relevant field is highly preferred.

Company

CitiusTech

Glassdoor

3.5

Major provider of technology services and solutions to healthcare technology companies, providers, payers and life sciences organizations

Founded in 2005

Princeton, New Jersey, USA

5001-10000 employees

http://citiustech.com

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

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Trends of Total Sponsorships

2023 (359)

2022 (385)

2021 (437)

2020 (425)