Employer Industry: Healthcare Services

Why consider this job opportunity:
- Competitive compensation and benefits package
- Opportunity for career advancement and growth within the organization
- Engage with both internal and external stakeholders to achieve business objectives
- Collaborative work environment focused on problem-solving and innovation
- Chance to make a significant impact on claims processing and healthcare delivery

What to Expect (Job Responsibilities):
- Ensure accurate and timely maintenance of critical claims databases and synchronize data among operational systems
- Validate data in compliance with business and system requirements related to contracting, benefits, and prior authorizations
- Train staff on configuration functionality, enhancements, and updates
- Create management reporting tools to facilitate communication regarding configuration updates
- Negotiate expected completion dates with Health Plans and document end-to-end business requirements

What is Required (Qualifications):
- Bachelor's Degree or equivalent combination of education and experience
- 7-9 years of experience in SQL, Medicare, Networx, QNXT, claims processing, and hospital claims payment methods
- Knowledge of Medicare payment methods and hospital claims processing
- Familiarity with Medicaid and Duals experience is highly preferred
- Understanding of Medicare fee schedule requirements

How to Stand Out (Preferred Qualifications):
- Graduate Degree or equivalent experience
- 10+ years of experience in relevant fields

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