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:

• Bachelors 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.
  

Required Skills:

Qualification: Bachelors 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.

Employment Type : Full Time
Experience: years
Vacancy: 1