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You will be updated with latest job alerts via emailCurative is looking for an Operations System Configuration Lead with significant expertise on the HealthRules
Payer platform who is passionate about helping the company as we work to reinvent healthcare options. Analyzes
business needs and processes to assist with developing implementing and maintaining the organizations
applications. Designs and builds complex configuration in the HeatlhRules Payor platform. Coordinates with
cross-functional teams to gather requirements by understanding workflow goals and processes. Acts as liaison
between teams to ensure solutions align with business objectives. Documents business requirements functional
specifications and process maps to serve as a reference for the organization. This is a remote position.
Responsibilities
Complete complex configuration design and build in the HealthRules Payer system to enable new healthcare products complex provider contracts capitation arrangements and workflows.
Use HealthRules Payer subject matter expertise to resolve platform issues around account implementation claims finance and enrollment.
Use HealthRules Payer Connector Services to build data load and extraction capabilities and advise the engineering teams on automation projects.
Collaborate closely with the Client Services Product and Engineering teams in planning and execution of strategic objectives.
Coordinate the planning prioritization and timeline of work tied to meeting company and team goals while closely tracking and communicating around the complex network of dependencies (and potential blockers).
Lead by example taking a senior role in the day-to-day work of the team.
Provide guidance and leadership in the implementation and maintenance of processes and systems to mature the operations of the team
Qualifications
Expert-level familiarity with the Health Rules Payer platform configuration and connector services. At least 5-10 years in a configuration role on Health Rules Payer.
At least 10-12 years of Health Care Enrollment/ Eligibility 834 EDI 837s Claims Processing and Health Plan Configuration experience required including HMO PPO ERISA and Medicare Advantage.
Demonstrated ability to configure complex facility contracts in Healthrules Designer.
Demonstrated ability to optimize benefit configuration in HealthRules Designer for accuracy scalability and maintainability.
Advanced Knowledge of claim coding and editing rules Optum/CMS
Ability to communicate with all levels of staff.
Knowledge of state regulations and requirements for claims payments HIPAA regulations medical terminology ICD-10 CPT and HCPCS coding.
Preferred experience working a variety of claims payment systems processing of all claim types to include hospital/facility behavioral health dental vision and professional medical claims.
Preferred experience working with the GuidingCare Medical Management system integrated into
HealthRules Payer.
Proficient computer skills to include Microsoft Office applications and Google Suite.
Excellent verbal and written communication skills and ability to communicate clearly and effectively.
Ability to sit for extended periods of time at a computer workstation.
Ability to Multitask and think creatively.
Education
Work Environment
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Required Experience:
Senior IC
Full-Time