Description

ESSENTIAL DUTIES:

•        Interacts directly with Business Leads, Delivery Lead, Vendors, and Technical Resources.

•        Works independently within guidelines, provides analytical support to customers on business application, infrastructure and technology related activities.

•        Provides guidance, assistance, coordination and follow-up on complex problems and ensures resolution.

•        Works with other team members, systems analysts, to implement complex projects.

•        Experience submitting CSRs and follow-up with NASCO.

•        Work independently and or in a team with little or no guidance.

•        Analyzes current business processes and systems to provide business process improvement ideas.

•        Gathers requirements and develop detailed documentation related to systems requirements and conceptual solutions.

•        Coordinates with testing center and other non- prime and prime areas.

•        Ability to work with and lead cross functional areas.

 

QUALIFICATIONS:

 

Other Skills: 4 Key required skills:

1.      Extensive claims and benefits experience is required (NPS).

2.      Extensive Analysis and Design experience including process flow development in Visio.

3.      Healthcare industry experience is required.

4.      Ability to handle multiple projects concurrently.

 

REQUIRED QUALIFICATIONS:  5+ years:

•        Extensive experience in Utilization Management and business functions. (Claims, NPS, Benefits, Pricing and Authorizations)

•        Knowledge of the Healthcare industry.

•        Excellent Communication Skills, both verbal and written.

•        Extensive MS Office tools including Visio.

•        Knowledge of SDLC/Waterfall/Agile.

•        Interpersonal and leadership skills including the ability to work with both internal and external customers and all levels of the organization.

•        Excellent problem solving, and conflict management skills including the ability to manage conflict and find mutually acceptable resolutions.

 


 

Education

Bachelor’s Degree