JOB SUMMARY
This job analyzes, codes, and compares basic client and group data, as well as provides general production support, meeting defined service level agreements. Assists in collaborating with internal stakeholders to understand low complex business requirements and processes related client, product, and benefits configuration solutions.
ESSENTIAL RESPONSIBILITIES
•Perform basic analysis using knowledge of simple business rules by interpreting data from various sources and formats and utilize the data for configuration activities.
•Process work requests for new work items and change requests related to end-to-end benefits solutions. May document and execute low to medium complex product and benefit configuration rules.
•Responsible for less complex verification that the delivered data and rule configurations meet the customer needs based on the product specifications, ensuring minimal coding errors in both configuration environments and production.
•Assist in and is accountable for identification, documentation, and escalation of risks, data errors and issues throughout the configuration process.
•Accountable to assist in providing configuration status and ensuring customer service level agreements are met.
•Identify coaching and training needs and address the same.
•Lead and motivate the team to success by fostering an environment of continuous improvement
•Manage all performance related matters with all team members; taking appropriate formal action as required.
•Other duties as assigned or requested.
EDUCATION
Required
•Graduate in any discipline
Substitutions
•None
EXPERIENCE
Required
•10 – 14 years of experience end to end Revenue Cycle Management (RCM) with 4 to 5 years in US Health Insurance Benefits or Benefit Coding
LICENSES AND CERTIFICATIONS
Required
•None
Preferred
•PAHM
SKILLS
•Good understanding of Healthcare value chain
•Perform business analysis and provide recommendations to process improvements
•Should be able to give inferences from the data analysis
•Ability to create the value stories
•Hands on experience in working on MS Office Suite
•Excellent detail-oriented skills
•Good customer service skills with some exposure working with customers, sales, and/or clients
•Good oral and written communication skills
•Ability to understand and resolve simple data relationships, data conflicts, and data discrepancies
•Ability to apply logical thinking and critical thinking skills
•Ability to understand and apply business rules and configuration concepts
•Ability to work independently, as well as, part of a team to produce results
•Ability to assess, resolve, and mitigate impacts to simple cross-functional and/or inter-related processes