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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