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Job Description
Job Summary: We are seeking a skilled Specialist to design develop configure and test Pricing Configuration. This role encompasses areas such as Practitioner Provider Fee Component Fee Schedule and Service Category for Supplier Contracts (Hospital/Physician/Ancillary). Responsibilities include testing Institutional Professional and Dental claims to ensure the configuration approach aligns with these contracts as well as ensuring timely maintenance and updates of configurations. Strong analytical skills attention to detail and effective communication with both technical and nontechnical audiences are essential for this role.
Key Responsibilities:
- Expertise in provider configuration and testing including Practitioner Provider Fee Component Fee Schedule and Service Category for Supplier Contract (Hospital/Physician/Ancillary) configuration.
- Skilled in pricing configuration ensuring the accurate and efficient setup and maintenance of pricing structures.
- Develop and implement pricing rules that determine how services are priced based on factors like provider type location and service category.
- Conduct thorough testing of pricing configurations to ensure accuracy and compliance with contracts and validate pricing outcomes against expected results for various claim scenarios (institutional professional dental).
- Analyze configure and test to maintain and support changes in contracts and procedures.
- Understand and analyze healthcare eligibility and claims data flow within the application.
- Regularly review and update pricing configurations to ensure they reflect changes in contracts regulations.
- Communicate clearly and effectively with diverse audiences including technical and nontechnical personnel.
Skillset for Pricing configuration
- Ability to develop and implement pricing strategies based on contracts requirement.
- Strong critical thinking skills to address pricing issues and optimize configurations.
- Ensuring precise setup and maintenance of pricing structures to avoid errors in billing and claims processing.
- Strong analytical and problemsolving skills.
- Excellent communication skills.
- Ability to work independently and as part of a team.
- Attention to detail and strong organizational skills.
- Basic knowledge of databases and SQL.
Candidate Profile:
Education/Qualification: Any Graduate
Work Experience: 5 8 years of experienceinUS health insurance benefit configuration and testing and At least 3 years of experienceworking withHRP applications.
Functional Skills: US Healthcare Benefits and Pricing configuration and testing.
Location PAN India
Required Experience:
Manager
Employment Type
Full-Time
