Sr. Claims Solutions Consultant

Jawood is a well recognized, well respected IT and Business Process Solutions Company.

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 ClaimCheck and CodeReview products.

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. Up to 50% travel required; remote home-based office for off travel hours.

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.
2. 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. 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.
3. Effectively participate on internal project teams. Conduct training needs analyses and develop implementation training materials. Lead internal project teams as required.
4. Enter labor, submit forecast, supply requested metrics and attend team meetings

Minimum Job Qualifications:

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

Software Tools:

MS Office

SAGE

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 !

Experience Hire Power with Jawood! See more of our OPEN HOT JOBS now!

Did you know that Jawood offers a REFERRAL BONUS ?

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