drjobs HealthRules Payor

HealthRules Payor

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1 Vacancy
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Job Location drjobs

Philadelphia, PA - USA

Monthly Salary drjobs

Not Disclosed

drjobs

Salary Not Disclosed

Vacancy

1 Vacancy

Job Description

Hi

Greetings For The Day

Im Symponia from SoftPath Technologies LLC and works in a Recruitment. We have a position for HealthRules Payor @ Remote in Philadelphia PA NJ locals or nearby only with our client and your profiles matches to requirement. Can you please check below JD and if you are interested then please share your updated resume to

Role: HealthRules Payor

Location: Remote in Philadelphia PA NJ locals or nearby only

Contract : 6 Months

Exp: 13 yrs

Job Description:

HRP is HealthRules Payor

HRP Configuration is the KEY

Resource to support our new MA PPO buildout and the ACA Exchange

Consulting Services to:

Provide business optimization on the following areas:

Provider contracting and claim pricing

Claims workflow and autoadjudication

Manual processes in place to address high Claim Review and Repair Workbasket volumes

Research contract configuration claim adjudication results HCC setup and policies and make potential recommendations on configuration changes to increase auto adjudication and reduce administrative cost where possible.

Reevaluate HealthRules Payor configuration:

To reduce manual work involved with new or renewed provider contract configuration

To increase autoadjudication with particular attention to the Provider contracting issues

To reduce manual work and pended claims volume particularly for Supplier Location and Practitioner Role matching issues

To optimize claims operations in other manners

To pay Providers accurately and on a timely basis

Thanks and Regards

Siluveru Symponia

(231)

Employment Type

Full Time

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