Healthcare Payer Claims Specialist

Title: Healthcare Payer Claims Specialist
Duration: Long-Term...
Interviews: Video
Location: ***Remote but need someone in one of the areas (or able to relocate to one of the areas if/when it becomes required) where they have an office.
Atlanta, GA; Bloomfield CT; Nashville TN; St. Louis, MS; Denver, CO; Dallas, TX; Austin, TX; Houston, TX; Boston, MA; Fairfax, VA; Morris Plains, NJ; Bloomington, MN; Philadelphia, PA; Scottsdale, AZ; Birmingham, AL.
Top 3 Skills
?? Deep understanding of Healthcare Payer Claims Transactions and Business Operations ?? 5+ years of healthcare payer claims experience.
?? Previous and deep interaction with healthcare Payer Claims Business Stakeholders.
?? 5+ years of Data Stewardship, enforcing operational Data Governance data policies, standards, and rules in real-time, across different data systems and sources. (Have dealt with handling variety, velocity, and volume of data via a flexible, dynamic, and scalable approach.
Responsibilities
?? Serves as Data Steward as part of an Agile team dedicated to Claims Transaction data operations & initiatives.
?? Leads Data Governance collaborations with Payer stakeholders to document, define, maintain, and manage Claims Transaction data standards and assets.
?? Assesses and monitors data quality metrics, analyzing trends and proactively promoting remediation and preventive action efforts.
?? Partners with IT and business teams to ensure the use of best practices and compliance with data standards.
?? Provides consultative stewardship services to delivery and issue resolution teams, serving as subject matter expert as needed.
?? Provides guidance on development, usage, and inventory of technical assets.
?? Represents GBS Data Governance in enterprise workgroups and data steward communities of practice.
Qualifications
?? Bachelor??s degree or higher
?? 5+ years professional work experience in:
?? Data Stewardship, Data Governance, Data Management and Data Quality practices
?? Healthcare Payer Claims Transactions and Revenue Cycle operations
?? Claims Transaction data standards and operations, including:
?? Patient check-in and registration
?? Eligibility verification
?? Medical coding ?? ICD-10, CPT, HCPCS, SNOMED CT - ASC X12N Implementation Guides
?? Claim submission
?? Claim processing
?? Claim payment
?? Claim reconciliation
?? Coordination of Benefits

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