HMS makes the healthcare system work better for everyone. We fight fraud, waste, and abuse so people have access to healthcare-now and in the future. Using innovative technology and powerful data analytics, we help government and commercial payers reduce costs, increase quality, and achieve regulatory compliance. We also help consumers take a more active role in their own health. Each year, we save our clients billions of dollars while helping people live healthier lives. At HMS, you will develop new skills and build your career in a dynamic industry while making a difference in the lives of others.
We are seeking a talented individual to serve as a Product Integration Solution Architect within our Payment Integrity division. The Solution Architect plays an integral role within the Payment Integrity division partnering with the Business Development and Implementation teams to assist in product process design education, finalizing product operational design within platform capabilities, facilitating data requirements, and ensuring adherence to HMS product guardrails. The Solution Architect participates directly with the market; and partners with HMS internal functional areas to support the implementation of the PI Product Suite both pre and post-sale.
This position functions depends upon the individual's ability to effectively work with prospects and client leadership, understand their specific needs, and design workflows to optimize the HMS PI product delivery. The Solution Architect is responsible for ensuring HMS's high standard of excellence is met while decreasing implementation timing, strengthening and scale internal product skill sets, and contributes to HMS' success to market and client credibility and deliverables.
This individual must be willing to travel on-site to meet with clients as needed.
Partner and provide Business Development support for presale and upsell opportunities, including presentations, Statement of Work language, and general product expertise to ensure consistency and quality in written and verbal communications
Interfaces across multiple applications areas to ensure that the appropriate platform capabilities and functionalities are accounted for in the product process design
Facilitate and lead client product design discussions
Finalization of client and HMS process design for the PI product suite.
Ensures the adherence to standards and guidelines set forth in the PI product guardrails
Communicate raw data source product requirements to the client and facilitate internal analysis partnering with the HMS QBO team
Communicate downstream production file requirements by product and customization sign-off with the client and the HMS Implementation team
Work with IT Application, Implementation, and Operations team members to confirm and/or develop requirements specifications for product implementation or new application functionality and customizations.
Maintain documentation and crucial artifacts required for an implementation and any applicable hand-off to Operations or the PI Implementation Team
Partners and provides assistance, as needed, with the Implementation Project Management Team and IT
Acts as an internal consultant, advocate, and mentor
Obtain client's internal processes and capabilities
Participate in implementation or project calls as needed for design or client discussions
Tracks, reports, and acts on applicable internal metrics for Solution Architect efforts, including monitoring Salesforce activities
Works with key business leaders to ensure alignment of product and platform features and capabilities
Knowledge, Skills and Abilities:
Ability to present and communicate ideas clearly and persuasively at all levels to both internal and external audience through relationship building and strong presence
Excellent writing skills
Ability to negotiate
Ability to work proficiently with Microsoft Excel, Word, and PowerPoint
Ability to lead presentations
Ability to work well with shifting priorities and timelines
Superior judgment and comfort level working with external clients specific to detailed process related discussions and articulating process requirements
Ability to develop relationships both in person and over the phone.
Ability to be careful and thorough about detail.
Ability to exercise independent judgment.
Knowledge of prospective and retrospective product processes related to: Clinical Claim Reviews, Payment Analytics, and Fraud Services
Knowledge of internal HMS product platform capabilities and functionalities a plus
Knowledge and understanding of raw data source requirements
Knowledge and understanding of downstream production file requirements
Ability to use logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions or approaches to problems and identify solutions.
Ability to multitask and handle multiple ongoing projects at once.
Ability to work in a fast paced environment.
Ability to foster and maintain strong working relationships within the company. Ability to complete tasks and work cooperatively with others.
healthcare industry and claims processing knowledge
Experience and/or knowledge of healthcare claim payer claim processing systems
Work Conditions and Physical Demands:
Primarily sedentary work in a general office environment
Ability to communicate and exchange information
Ability to comprehend and interpret documents and data
Requires occasional standing, walking, lifting, and moving objects (up to 10 lbs.)
Requires manual dexterity to use computer, telephone and peripherals
May be required to work extended hours for special business needs
May be required to travel at least 30% of time based on business needs
Minimum Related Work Experience:
8 years of experience in healthcare, preferably a claim payment or audit recovery environment
5 years of external client facing experience
4 years working collaboratively with Information Technology and multiple organizational departments
Strong healthcare data knowledge (UB, HCFA) of all claim types
5 years of experience in requirements gathering, systems integrations, data onboarding, process flow design and project management.
Prior successful experience working directly with senior management, specifically with identification, analysis, presentation and execution of projects
Nothing in this job description restricts management's right to assign or reassign duties and responsibilities to this job at any time.
EOE including disability/veteran.