Sr. Claims Solutions Consultant - AW975

Jawood, a Certified Women's Business Enterprise, is a well recognized, well respected IT and Business Process Solutions Company. We have 20 years of experience meeting global clients' needs in consulting, special projects, staff augmentation and training ventures (on-site, off-site and off-shore). Not only has Jawood earned a reputation for excellence by providing the finest talent to augment clients' staffing needs , but we also have the proven ability to assemble the right task force to provide business process solutions and complete entire projects of any size.

Jawood's flexible, people-centered culture is unique and attracts top talent, worldwide. The best surround themselves with the best . We call it Hire Power !

We currently have an opportunity for a Sr. Claims Solutions Consultant who is responsible for providing functional, and integration expertise for the implementation of the Health Solution's core products (ClaimCheck, ClaimCheck Plus (with Wizard and Policy Administration Module components), CodeReview, C3, InvestiClaim, and Contract Symphony).

Position Summary:

This position is responsible for understanding the customer's business processes, claims environment, payment policies and performing consultative business services to achieve high customer satisfaction and return on investment.

Key Responsibilities:

1. Independently lead large or complex implementation projects providing function and detail design specifications. Responsible for conducting project management, training and education classes for employees or customers regarding features and operation of ClaimCheck/ClaimCheck Plus/CodeReview/C3 processes, technology and resource competencies for solutions. Able to translate customers business and medical policy requirements to product configuration. Perform additional service offerings and billable consultative services as required. Identifies and helps market implementation projects and additional services offerings to generate revenue.

1. Able to translate customers business and medical policy requirements to product configuration. Guide and assist customers in the process of performing a ClaimCheck knowledge base review. The process consists of educating customers on the core edits and basic clinical logic included in the product. In addition, assist the customer in evaluating their medical and claims processing policy guidelines for alignment with ClaimCheck editing/logic and determine customization requirements. Analyze data reports (created from paid claims data processed through ClaimCheck) to access alignment between the product and policies.

1. Effectively participate on internal project teams. Conduct training needs analyses and develop implementation training materials. Lead internal project teams as required.

1. Enter labor, submit forecast, supply requested metrics and attend team meetings

Minimum Job Qualifications:

I. Education/Training

Bachelor's Degree in computer science, healthcare related field, or equivalent business experience

Formally trained on the features and functionality of ClaimCheck or CodeReview

II. Business Experience

5 years of experience in health care combining first hand payor, consulting, and training experience

2 to 3 years effectively performing implementations and additional service offerings on ClaimCheck, CodeReview, or C3

III. Specialized Knowledge/Skills

A. Products and Services

Understands the features and benefits of all CACD products and services

Explains all CACD products and services effortlessly to customers

Understands the resource requirements for implementing CACD products and services

Demonstrates effective use of the ClaimCheck/CodeReview/C3 product and services

Understands the CACD overall strategic plan

B. Customer's Business

Deeply understands the payor environment and claims management

Deeply understands the different customer segments (national, strategic, and specialized)

Understands architecture, infrastructure, and multiple platforms

Discusses customer issues (pains and trends) confidently with customers

Works with management to create new methodologies to streamline processes

Understands the development and application of Payor medical and payment policies and general overlap with product logic and functionality

C. Communication

Delivers presentations effectively to the customer

Attends and delivers presentations at the conferences

Able to understand and articulate product knowledge packs effortlessly

Conducts customer meetings/trainings efficiently and effectively

D. Business Processes

Understands all of the phases of the service and support cycle: design, implementation, and support

Deeply understands product and solution life cycle

E. Operations

Effectively addresses assigned customer requests and issues

Garners customer feedback through training surveys and post engagement surveys

Mentors other members of the team on specific initiatives as required

Represents the team in cross functional activities

F. Clinical

Understands medical terminology, healthcare industry terminology, and coding terminology and industry coding ICD9, CPT, HCPCS

Ability to understand and interpret Payor medical policies that include medical necessity guidelines, experimental and investigational guidelines and payment policy guidelines.

Analytical skills to utilize product clinical documentation and data analysis reports in identifying conflicts between the product editing logic and the policies and to identify product customization/configuration requirements.

Articulates the clinical value of products and services provided to customers

G. Software Tools

High-level proficiency in the following software:

Word

PowerPoint

Excel

SAGE

Visual Basic a plus

Other tools used for shared Solution Services communication, such as Web conferencing

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