United States onlyBe part of our amazing transformational journey as we optimize the opportunity towards becoming a leading technology, data, and innovation voice in healthcare. Onward and Upward!!!
JOB ROLES AND RESPONSIBILITIES:1. Manage the efforts to fulfill a client request to access Claritev products, and to customize how they access/utilize Claritev Products using EDI and Web Services claims processing workflows. It includes but is not limited to the below:
* Understanding client needs
* Researching current client setup & claim processing rules
* Designing the quickest and most efficient solution
* Communicating effort, timelines, risk and client impact
* Implementing the solution and validating that it works as intended
* Performing end-to-end client-facing and regression testing
* Enabling client solution in the production environment
* Monitoring/Reporting/Turnover to Production Support2. Act as the primary liaison between business and technical teams.
* Build and maintain positive working relationships with internal colleagues (including IT, Sales and Marketing, and Operations) and external contacts.3. Manage and coordinate IT deliverables to both internal and external stakeholders
* Participate in implementation meetings with clients and vendors committed to establishing a partnership with Claritev.
* Provide HIPAA-compliant guidance to clients requesting additional information about Claritev requirements and industry standards for EDI protocols.
* Ensure proper setup of all systems that support file transfer and claims processing between Claritev and clients.
* Work on standard as well as custom, non-standard projects on a daily basis including implementing clients who send proprietary format claim files.
* Conduct necessary testing and in-depth analysis to resolve any potential issues prior to rolling clients into the production environment.
* Constructively present testing results and propose adjustments that will improve service delivery to our clients and strengthen our ongoing partnership.
* Monitor, audit, and report on the processing of newly implemented clients/features to confirm their successful transition to the production environment.
* Support testing for rollouts of new products as well as internal system migrations.
* Proactively prioritize, communicate, and resolve any process or system issues.
* Analysis and reporting on client enquiries. Finding gaps and proposing viable solutions.4. Manage requests and incidents using problem solving and critical thinking abilities
* Promptly triage and resolve escalated EDI issues called into the Claritev Service Desk.
* Independently build and manage the monitoring requirements of clients on a daily, weekly and monthly basis.
* Communicate system and interface availability, modifications, and problems to internal and external stakeholders as needed and according to established policies and procedures.
* Support clients with their non-standard requests for ad hoc reports, testing analysis and other technical deliverables.5. Implement process improvements to enhance the efficiency of claims workflows.
* Partner with other IT teams to implement enhancements and defect fixes.
* Report progress & measurements of implementation success to clients and all stakeholders.
* Perform routine and ad hoc analysis of various facets of claims processing including but not limited to system performance, claim turnaround times, data mapping, and claim volumes.
* Analyze data to identify potential process improvement opportunities.
* Perform gap analysis, communicate and implement potential solutions.
* Proactively remain informed on ever changing client specific business rules to ensure accuracy.
6. Prepare and maintain documentation that defines operational procedures, describes client requirements, and share relevant analysis outcomes with internal and external stakeholders.
* Contribute to building and maintenance of knowledge repository on processes and procedures on a regular basis.
* Present information learned as part of daily work with the larger team.7. Exhibit excellent team work
* Provide coverage and support for other team members as needed.
* Support Manager with team goals and corporate strategies.
* Assist with the training and coaching of junior team members.
* Support deployment activities during release weekends if needed.
8. Collaborate, coordinate, and communicate across disciplines and departments.
9. Ensure compliance with HIPAA regulations and requirements.
10. Demonstrate Company's Core Competencies and values held within.
11. Please note due to the exposure of PHI sensitive data -- this role is considered to be a High Risk Role.QualificationsJOB REQUIREMENTS (Education, Experience, and Training):
- Bachelor’s Degree in a related discipline or the equivalent combination of work experience and technical training.
- 5+ years progressively responsible experience in healthcare analyst
- Comprehensive understanding of Healthcare IT claims processing
- Prior experience with EDI and Web Services/ XML
- Prior experience with FTP (File transfer protocols).
- Clear understanding and working knowledge of HIPAA EDI protocols.
- Strong knowledge of and the ability to read, edit and work with HIPAA EDI 5010 X12 Transactions such as 837, 997, 999, 834, 835, 277, 271.
- 837P and 837I knowledge is critical.
- Prior experience of working on non-standard file format is a plus.
- Strong SQL
- Ability to write complex queries utilizing multiple tables and datasets to analyze and evaluate EDI data within an Oracle database.
- Advanced experience working with below
- Reporting tools like MS Excel, Tableau.
- MS Word, PowerPoint.
- Service Now, Confluence, JIRA.
- Text editors like Ultraedit, Textpad, Notepad++.
- Applications like Specbuilder, Beyond compare
- Knowledge of ETL is a plus.
- Testing experience is strongly preferred (functional and regression)
- Working with developers, product managers, scrum masters and other stakeholders to understand requirements and testing expectations clearly.
- Creating and executing test plans, building test cases, and writing scripts to validate code change and perform unit, functional and regression testing.
- Creating detailed test reports, documenting test results, and contributing to documentation.
- Ability to analyze test results, identify root causes of technical and functional issues, and suggesting solutions for improvement.
- Utilizing defect tracking systems to record, communicate, escalate and follow up on bugs to ensure their resolution.
Soft Skills:
- Exceptional critical thinking, analytical and troubleshooting skills.
- Superior customer service skills, preferably in a technical implementation capacity.
- Experience working in a professional environment and to maintain accountability and ownership with minimum supervision.
- Ability to work independently and as a member of a team.
- Ability to manage supervisor expectations as well as help review work for junior team members.
- Clear and concise verbal and written communication skills.
- Ability to assimilate new and existing technologies as part of self-learning from available documentation.
- Ability to lead a complex and custom project as an SME and to delegate work to junior members if necessary, with feedback from manager.
- Leadership skills to pick up knowledge quicker than junior analysts and to contribute effectively on projects.
- Ability to manage multiple tasks and projects and prioritize them effectively.
- Ability to understand the big picture as well as meticulously focus on details.
- Embracing change with a positive attitude and willingness to adapt well.
COMPENSATION
The salary range for this position is $100K to $110K. Specific offers take into account a candidate's education, experience and skills, as well as the candidate's work location and internal equity. This position is also eligible for health insurance, 401k and bonus opportunity.
BENEFITS
We realize that our employees are instrumental to our success, and we reward them accordingly with very competitive compensation and benefits packages, an incentive bonus program, as well as recognition and awards programs. Our work environment is friendly and supportive, and we offer flexible schedules whenever possible, as well as a wide range of live and web-based professional development and educational programs to prepare you for advancement opportunities.
Your benefits will include:
- Medical, dental and vision coverage with low deductible & copay
- Life insurance
- Short and long-term disability
- Paid Parental Leave
- 401(k) + match
- Employee Stock Purchase Plan
- Generous Paid Time Off – accrued based on years of service
- WA Candidates: the accrual rate is 4.61 hours every other week for the first two years of tenure before increasing with additional years of service
- 10 paid company holidays
- Tuition reimbursement
- Flexible Spending Account
- Employee Assistance Program
- Sick time benefits – for eligible employees, one hour of sick time for every 30 hours worked, up to a maximum accrual of 40 hours per calendar year, unless the laws of the state in which the employee is located provide for more generous sick time benefits.
EEO STATEMENT
Claritev is an Equal Opportunity Employer and complies with all applicable laws and regulations. Qualified applicants will receive consideration for employment without regard to age, race, color, religion, gender, sexual orientation, gender identity, national origin, disability or protected veteran status. If you would like more information on your EEO rights under the law, please click here.
APPLICATION DEADLINE
We will generally accept applications for at least 5 calendar days from the posting date or as long as the job remains posted.
