Healthedge Healthrules Configuration Consultant

Location: Remote
Duration: 6 Months
Industry: Healthcare/Health Insurance

The HealthEdge/HealthRules Configuration Consultant will be responsible for configuring and optimizing the HealthEdge HealthRules platform to meet clientspecific requirements. This role involves understanding healthcare business processes working with crossfunctional teams and ensuring seamless system integration. The consultant will lead efforts in configuring benefits claims provider networks and other core health plan components while ensuring compliance with healthcare standards and regulations.

• Configure and customize the HealthEdge HealthRules platform to support the operational needs of health insurance clients.
• Translate business requirements into technical specifications focusing on claims benefits member provider and billing modules.
• Work closely with business stakeholders solution architects and technical teams to gather requirements design solutions and implement system configurations.
• Conduct gap analysis between business needs and system capabilities recommending solutions for optimal performance.
• Manage and maintain configuration documentation ensuring all changes and customizations are welldocumented.
• Perform impact analysis of new configurations or changes in the system.
• Troubleshoot and resolve configuration issues providing technical support as needed.
• Collaborate with IT and business units to ensure HealthEdge HealthRules platform aligns with organizational goals and compliance requirements.
• Ensure configurations comply with healthcare industry standards and regulatory requirements such as HIPAA.
• Participate in user acceptance testing (UAT) to ensure configurations meet client expectations and business requirements.
• Train users and provide postimplementation support to business and technical teams.

• Bachelors degree in Computer Science Information Systems Healthcare Administration or a related field.
• 3 years of experience in configuring HealthEdge HealthRules or similar healthcare payer platforms.
• Strong understanding of healthcare industry processes especially in claims benefits provider and billing modules.
• Expertise in healthcare standards and regulatory requirements (HIPAA ICD CPT ANSI X12).
• Proficient in SQL and experience with relational databases (e.g. Oracle MS SQL).
• Experience with Agile and Waterfall development methodologies.
• Ability to interpret complex business requirements and translate them into technical specifications.
• Strong troubleshooting skills and the ability to handle multiple tasks in a fastpaced environment.
• Excellent communication and collaboration skills with the ability to work effectively in crossfunctional teams.

• Certification or specialized training in HealthEdge HealthRules.
• Experience working with Medicare Medicaid and commercial healthcare plans.
• Knowledge of HealthRules integration with thirdparty applications (e.g. claims systems data warehouses).
• Familiarity with automation tools and testing frameworks (e.g. Selenium Postman).
• Experience with business process reengineering or process improvement.

• Strong analytical and problemsolving skills.
• Ability to work independently and manage project deadlines.
• Excellent verbal and written communication skills.
• A proactive approach to learning new systems and technologies.