Cosmos Configuration Lead

Cosmos Configuration Lead

Experience:

• 8 Years

Location:

• US

As a COSMOS Configuration Analyst you must be highly organized and detailoriented with strong analytical problemsolving and prioritization skills. You should also be able to handle multiple tasks in a fastpaced deadlinedriven environment both independently and as part of a team. It is also important that you display excellent verbal and written communication and interpersonal skills as well as the ability to effectively present information and respond to questions from groups of managers and clients.

Responsibilities:

• Understanding of US Healthcare Payor workstreams including Claims Network and Pricing Provider Management Medical Management Premium Billing and Payment Member Enrollments Benefits Management.
• Wellversed with various lines of business specifically Medicare.
• Healthcare industry standards and codes usage ICD10 HCPCS CPT Revenue Codes DRG APC and NDC.
• Experience with COSMOS/UNET/NICE.
• COSMOS Configuration: Set up of Benefit Plan Network and Supplier Contracts (Pricing) Providers Enrollment Premium and Account subaccounts etc.
• Review interpret and/or verify contract language information and intent to load information into systems properly. Ensure contract templates can be administered across operations (pricing config claims etc.).
• Work with provider contracting staff when new/modified reimbursement contracts are needed.
• Interacting with customers internal stakeholders and other thirdparty vendors for requirements gathering architecture and design discussions development testing and other activities.
• Perform preadjudication claims reviews to ensure proper coding was used.
• Communicate and/or collaborate with internal business partners to identify process improvement opportunities.
• Mentor and guide the team on technology frameworks and processes and ensure quality of deliverables. Support testing and deployment of COSMOS.

Educational Qualifications:

• Bachelors degree in computer science information technology or a similarly relevant field is highly preferred.