HCL Technologies in Cary, NC
- Industry: Advertising/Marketing/Public Relations - Marketing Director
- Type: Full Time
- Compensation: $145,400.00 - 145,400.00 / Year*
HCL Digital Consulting practice has a full time opportunity for a Healthcare Proxy Product Owner/Domain SME in Cary, NC. Overview: Translate business needs into clearly defined and documented, high quality requirements and/or supplemental specifications for new applications. Analyze data to determine business problems. Handles information including patient services and how services are paid. Work with teams to identify charge system weakness, recommend changes and focused education. Ensure adherence to compliance policies and contracts. Responsibilities: Review, analyze, and evaluate business processes and associated IT application requirements. Develop and execute test strategies, plans, scenarios, and tracks resolution to identified defects. Define and document business and IT system processes. Models AS-IS and TO-BE processes. Conduct and facilitate JAD sessions to develop and coordinate the requirements, specifications, design, and testing efforts. Analyze business workflow and system needs for conversions and migrations; assists in data mapping. Analyze change requests/enhancements in existing applications. Conduct gap analysis, identify root cause and assist with problem management. Prepare high level user documentation and training materials. Experience/Skills Required 12+ years of experience working as a domain SME for a health plan 4+ years of Healthcare experience in any of the following: o Core Administration Modules, Claims, Enrollment & Billing Delivery, Program Management, Product Management, or Network Management Strong consulting experience & exposure to IT Healthcare sales cycle Preferred 4+ years of experience in one or more of the following: o Operational business process improvement/analysis, benchmark or workflow analysis o Ability to work on claims with different LOBs such as Commercial, Medicare, Medicaid etc. o Knowledge and experience of Medicare & Medicaid state level reporting levels o Strong understanding of healthcare data formats, standards; map to CMS and state reporting. Exposure to claim functionalities such as Edits, COBs, claims adjustments, Episodes etc. Preferred Skills: Exposure to IKA systems or Facets claims adjudication is an advantage Exposure to ITS claims and duals is an advantage Knowledge and experience with Medicare & Medicaid Past use of any data base program such as MS Access is a plus Travel Readiness to 40% (mostly to Richmond, VA) Educational Background: Additional degree MBA, MHA preferred
* Estimated salary
More Jobs Hiring Near Me!