Provides support for significant Medicare and Exchange product and benefit initiatives. This includes new product offerings as well as support for business migrating from legacy platforms.
Successful candidates will have a mix of product and benefits knowledge and it65533s use in claims adjudication processing. If your goal is to combine your strong knowledge product/benefit knowledge, Medicare or Exchange, with a bent for analytic and technical implementation, then this is the ideal job for you. You will determine the best approach for driving the desired benefit outcomes in claims processing and provider payment.
Experience with coding standards, ICD 10 and CPT codes would be beneficial. You will also need to evaluate the impact of CMS and state legislation on benefit plans. This is a unique opportunity to be on a dynamic Team that is shaping the new delivery of healthcare.
Prior knowledge and experience with the Health Edge Health Rules Payor platform and HRL Language for complex benefit configuration is highly desired. May independently manage midsize product enhancements.Demonstrated analysis and critical thinking and skills, with strong knowledge of product and benefit plan configuration on a business owned and maintained platform. Ideal candidates understand the interaction of benefits, provider networks and claims adjudication outcomes. () Communicates product features and fundamental components to the organization that reflects the product and responds to the needs of various 65533stakeholders65533 (i.e., employees, customers, shareholders) while communicating the need and rationale for policies and standards.() Represents Medicare NextGen Product and Benefit Configuration capabilities and strategy in cross functional meetings and related project activities, e.g. Medicare Product and Marketplace Offerings for Individual and Group bid filings, Legislative Review Committee, and Operational Support areas. '239614