Medical Claims SME

Job Title:

Medical Claims SME Job :

Job Location:

Whippany, NJ (2-3x/week hybrid) Job Travel Location(s): # Positions: 1

Employment Type:

W2 Candidate Constraints:
Duration:
Long Term # of Layers: 0 Work Eligibility:
All Work Authorizations are Permitted – No Visa Transfers Key Technology: coding principles, benefits, pricing, third-party liability, billing, payment, adjustments, reconciliation, rebilling, refunds, denials

Job Responsibilities:

• Perform current claims process analysis, risk analysis, impact analysis
• Collaborate with technical and business teams to stitch together the current state of the Claims system and processes
• Advise best practices around Claims processing and data governance
• Design data and processes to meet regulatory requirements and business needs
• Provide claims domain knowledge expertise in refining the existing Claims processes

• Medical Claims Professional who has subject matter expertise in data requirements and processing for the analysis and resolution of claims, including coding principles, benefits, pricing, third-party liability, billing, payment, adjustments, reconciliation, rebilling, refunds, denials.
• Demonstrate working understanding of claims processing systems and working knowledge of the health care industry.
• Business Systems Analysis experience in claim processing and structures.
• Meet with business areas to gather process and integration requirements to ensure claims are processed correctly to prevent the company from liabilities.
• Experience with design of claims business process and systems

• Quick learner
• Detail oriented
• Must have analytical capacity to solve business problems
• Excellent communication skills, both written and verbal
• Ability to collaborate with different teams and able to execute projects in a timely manner

• Expert knowledge of Medical Claims Processing
• Experience with FACETS Claims Processing