Senior - Support Analyst

MANDATORY SKILLS

Domain Competencies (APPS)Bus. ProcessHealthcareBus. ProcessHealthcare

Experience in Claims Payer Domain using Facets Strong in SQL
As the SME for Claims the resource will play a pivotal role in providing expert guidance strategic insights and technical expertise related to claims processing within the healthcare payer industry. The ideal candidate should possess an indepth understanding of claims systems regulatory compliance and industry best practices.
Serve as the primary point of contact and subject matter expert for all matters related to claims processing systems.
Provide indepth knowledge of claims adjudication configuration and optimization of claims systems.
Stay abreast of evolving healthcare regulations payer guidelines and industry standards related to claims processing.
Interpret and communicate regulatory changes to internal stakeholders ensuring compliance in all aspects of claims operations.
Analyze and evaluate current claims processing workflows identifying opportunities for optimization and efficiency improvement.
Develop and implement best practices to streamline claims operations while maintaining high accuracy and compliance standards.
Indepth knowledge of healthcare coding systems (ICD10 CPT HCPCS) and extensive experience in claims adjudication.
Familiarity with relevant regulations such as HIPAA and experience in implementing compliance measures.