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Application Specialist Healthcare Insurance Systems (Billing)

Job Description - Application Specialist Healthcare Insurance Systems (Billing)

Responsibilities:

  • Assist in the configuration, maintenance, and troubleshooting of RCM, Billing, and Insurance systems to ensure compliance operational requirements.
  • Support billing rules setup, corporate accounts, exemptions, markups, and pre -authorization workflows as per health insurance standards.
  • Provide support for claims lifecycle processes, including eligibility checks, pre -authorizations, billing, coding, claim submissions, and remittance processing.
  • Support the integration of insurance data with internal EMR and financial systems, with a focus on Cerner workflows.
  • Collaborate with Finance and Insurance teams to document business requirements and assist in translating them into system workflows.
  • Prepare and execute test cases for System Testing, User Acceptance Testing (UAT), Unit Testing (UT), and Functional Testing (FT), focusing on system functionality and compliance.
  • Provide end -user training and support, including the development of training materials for system functionalities related to insurance workflows.
  • Assist in data migration tasks, including preparing data migration templates and data collection worksheets to ensure seamless system transitions.
  • Perform Master Data Mapping for insurance -related workflows, ensuring data consistency across systems.
  • Participate in system upgrades, patches, and testing cycles to ensure optimal system performance.
  • Prepare functional documentation, including SOW, workflows, and best practice.
  • Provide on -site and remote support during go -live and post -go -live phases to ensure operational stability.
  • Willingness to work in shifts to support critical project and operational needs


Requirements

Qualification:
  • Bachelor's degree in Information Technology, Healthcare Informatics, Business Administration or a related field.
  • 6+ years of experience in healthcare IT, particularly in RCM, Billing, and Insurance systems.
  • Expert understanding of claims management processes, including eligibility verification, pre -authorizations, and remittances.
  • Hands -on experience with EMR/EHR platforms (e.g., Cerner, Epic, Oracle Health or equivalent EMR) and their insurance workflows.
  • Proficiency in Microsoft Visio for process documentation and workflow design.
Skills:
  • Strong understanding of billing and insurance workflows, including Fee for Service, DRG (Diagnosis -Related Groups), and insurance agreements.
  • Ability to troubleshoot technical system issues and support end -users in resolving functional problems.
  • Strong analytical and documentation skills for tracking system performance and reporting issues.
  • Understanding of HL7 messaging formats and ability to validate insurance -related transactions.
  • Flexibility to work in shifts to provide necessary system support.

Original job Application Specialist Healthcare Insurance Systems (Billing) posted on GrabJobs ©. To flag any issues with this job please use the Report Job button on GrabJobs.
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