Payer Configuration Analyst

🔥 21 hours ago

🇺🇸 United States – Remote

💵 $85k - $100k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

🧐 Analyst

🚫👨‍🎓 No degree required

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

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HealthEdge

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2005

🏥 Healthcare

💼 Consulting

⚕️ Healthcare Insurance

Healthcare • Consulting • Healthcare Insurance

HealthEdge is a company that specializes in providing advanced solutions for healthcare payers through its HealthRules Solutions Suite. This suite includes a comprehensive digital claims administration processing system, care management workflow solutions, and payment integrity solutions, which aim to enhance operational efficiency and improve quality of care for health plans. By leveraging integrated technology and automation, HealthEdge helps health plans eliminate data silos, increase payment accuracy, and elevate member experience, thereby transforming the healthcare landscape for better collaboration and accessibility.

📋 Description

• Support daily operations of an assigned client • Interact with clients and offshore counterparts to work tickets and meet business needs • Manage incidents, gather requirements, configure and unit test HealthRules Payor software • Provide configuration requirements to offshore team members • Validate offshore configuration activities through peer reviews • Monitor claim impact reports for accuracy and integrity • Analyze claim impact reports for reprocessing projects to assess financial impact • Perform quality reviews to ensure analytical accuracy and integrity • Identify opportunities to improve processes through automation • Analyze business requirements and test complex scenarios independently and collaboratively • Track tickets and formulate remediation plans • Comply with the Code of Conduct, regulatory and contractual requirements, policies, procedures and internal controls

🎯 Requirements

• Excellent communication and presentation skills, including ability to convey business requirements/configuration effectively with clients and offshore team members • Experience in at least one module of HealthRules Payor (e.g., Benefits, Pricing, Claims, Finance) • Strong analytical and problem-solving skills • 2+ years HealthRules Payer Configuration experience • Hands-on experience within Pricing and Contracts • Source and Editing experience preferred • Eagerness to learn and adapt to a fast-paced environment • Detail oriented • Good communication skills • Self-starter • Agile Methodology preferred • Ability to work across multiple time zones • Candidates may be required to complete a pre-employment criminal background check

🏖️ Benefits

• Opportunities to improve processes through automation, driving efficiency and reducing manual effort • Opportunities to work across multiple time zones in a hybrid or remote work environment • May require travel dependent on company needs • Reasonable accommodations for individuals with disabilities • Equal opportunity and workforce diversity commitment

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