- Mandatory Skill Set: Experience working within the Healthcare Provider domain, with a strong understanding of hospital workflows and operational support.
- Incident Problem Management: Investigate, troubleshoot, and resolve L2/L3 incidents for COTS healthcare applications, ensuring timely restoration of services and adherence to SLAs; perform root cause analysis for recurring issues.
- Application Monitoring Maintenance: Proactively monitor application health, interfaces, and batch jobs; perform regular maintenance, patch validation, and upgrades in coordination with vendors and internal teams.
- Change Release Support: Assess, implement, and validate application changes (configurations, patches, upgrades) through controlled release processes, including impact analysis and rollback planning.
- Stakeholder Vendor Coordination: Act as a liaison between business users, IT teams, and third-party vendors for issue resolution, enhancements, and escalations, particularly for regulated healthcare workflows.
- Compliance Documentation: Maintain knowledge articles, runbooks, and audit documentation; ensure adherence to healthcare regulations (e.g., HIPAA), security standards, and data privacy requirements
Skill Description
Understanding of claims lifecycle, billing rules, payer edits, ERA/EOB reconciliation
Skills managing EDI transactions (837, 835) and clearinghouse workflows
Ability to troubleshoot claim rejections, scrubbing rules, and payer configurations
Experience with patient estimates, statements, payment plans
Knowledge of Medicare/Medicaid requirements, including NOE submissions
Analytics skills for denial trending, root cause, and cash recovery
Experience working with Patient Financial Services systems like EDI Claim Reconciler, Invision,Clearinghouse Service and other similar applications
