Role & Responsibilities :
Configuring client System for Pricing (Provider Contract) as per the requirement and according to defined business rules of new claims processing platform.
Evaluation of Pricing Configuration Requirement and Formulation of Configuration Approach and Effectively include advanced configuration and additional functionality based on best practices
Based on the business requirements and business rules gathered, evaluate and create rules and complete the pricing configuration activities
Participate in problem solving of Health Plan benefit, provider, pricing, reporting, operational and system issues
Perform a variety of tasks related to the resolution of production support issues based on client configurations with the core administrative system
Support activities to update configuration within the core claims processing system, typically within the areas of Provider Pricing.
Potential responsibilities include and may vary by system area of assignment
Support fee schedule changes including terms, affiliations and contract maintenance
Enable User Analysis Testing (UAT) and implement the modifications as suggested by the business owners and / or analyst
Creating manual test cases from Use cases, Functional specs and other requirement documents.
Resolve coding / QA issues by managing Master Issue Logs and Fixing the high priority change requests which require immediate attention
Data Validation and Audit of existing plans and contracts in the client database(s)
Database Management & Maintenance
Basic Requirements :
6 to 8 years of experience completing the configuration and design of provider contracts
4 to 5 years of Provider pricing configuration experience
3+ years conducting UAT in provider contracts.
Preferred 3+ years of experience completing or working with business requirements and / or functional design documents
Possesses strong knowledge of claims processing and associated business processes
Prior experience working with DST system pricer and Amysis system knowledge is a plus
Ability to create and run basic system queries using SQL, Access or other tools is required
Preferred : Knowledge of US Government Health Care Plans Medicaid / Medicare
Pls feel free to reach me 9524797517 if you have queries.