oct. 2020 - Présent
Delivered projects related to the development and configuration of new business, provider contracts, claims editing, reference data and their enhancements including claims configuration improvements, compliance and systems enhancements.
Provided support to the claims configuration process in addition to providing claims triage and configuration troubleshooting.
Ensured that business requirements for claims configuration change requests are clearly understood, documented, communicated, tested, and delivered.
Experience with data analysis and query tools that utilize functions that include creating standardized reports, utilizing VLOOKUPs, pivot tables, filtering and formulas.
Experience utilizing analysis tools such as SQL, project tracking, testing and requirement tools.
Hands-on experience and knowledge of rules based table driven claims and eligibility administration systems.
Proficient in medical terminology, medical coding (CPT4 , ICD9 or ICD10 , and HCPCS) , provider contract concepts and common claims processing/resolution practices.