Inforeem Job Portal

Healthcare Business Consultant

Location: Princeton, NJ
Date Posted: 01-24-2018
or
Healthcare Business Consultant
NJ

translates business needs into clearly defined and documented detailed, high quality requirements and/or supplemental specifications for new applications or analyzes change requests/enhancements in existing applications. Analyzes data to determine business problems. Handles information including patient services and how the services are paid after conducting investigations and pursuing recoveries through contact with various parties. The Analyst works collaboratively within or outside the team to identify charge system weakness, to recommend changes and focused education. Will also ensure adherence to compliance policies and contracts.
  • Defines and documents business and IT system processes. Models AS-IS and TO-BE processes. 
  • Document business analysis deliverables such as requirements, workflow diagrams, and testing documentation 
  • Facilitate communication and work collaboratively with cross functional teams.
  • Accountable for complex claim related issues
  • Conducts and facilitates JAD sessions to develop and coordinate the requirements, specifications, design, and testing efforts for medium to large projects with all the stakeholders. 
  • Analyze claims, Identify potential problems and trends, conduct root cause analysis to add enhancements, redesign of systems and improve efficiency
  • Analyzes business workflow and system needs for conversions and migrations; assists in data mapping.
  • Reviews, analyzes, and evaluates business processes and associated IT application requirements.  
  • Prepares high level user documentation and training materials and provide trainings to project teams
  • Ability to work independently as well as organize and coordinate work with others 
  • Understanding of Population Health Management(PHM) solution is strongly preferred
Knowledge skills and Abilities
  • Possess healthcare Industry expertise with a good understanding on the Health IT infrastructure to suggest and develop innovate solutions to business and technology platforms
  • Ability to work on claims with different LOBs such as Commercial, Medicare, Medicaid etc
  • Good understanding on the lifecycle of claims adjudication
  • Possess good exposure on the various claim functionalities such as Edits, COBs, claims adjustments, Episodes etc.
  • Exposure to Facets claims adjudication is an advantage
  • Exposure to ITS claims and duals is an advantage
  • Knowledge on Healthcare standards appropriate to claims
  • Knowledge on Medical Reimbursement policies, procedures and standards
  • Interpret federal and State laws and regulations
  • Good communication, Inter-personal and documentation skills
  • Should possess good data analysis skills.  
this job portal is powered by CATS