Healthcare Payer Claims Specialist

Title: Healthcare Payer Claims Specialist Duration: Long-Term... Interviews: Video Location: ***Remote but need someone in one of the areas (or able to relocate to one of the areas if/when it becomes required) where they have an office. Atlanta, GA; Bloomfield CT; Nashville TN; St. Louis, MS; Denver, CO; Dallas, TX; Austin, TX; Houston, TX; Boston, MA; Fairfax, VA; Morris Plains, NJ; Bloomington, MN; Philadelphia, PA; Scottsdale, AZ; Birmingham, AL. Top 3 Skills • Deep understanding of Healthcare Payer Claims Transactions and Business Operations – 5+ years of healthcare payer claims experience. • Previous and deep interaction with healthcare Payer Claims Business Stakeholders. • 5+ years of Data Stewardship, enforcing operational Data Governance data policies, standards, and rules in real-time, across different data systems and sources. (Have dealt with handling variety, velocity, and volume of data via a flexible, dynamic, and scalable approach. Responsibilities • Serves as Data Steward as part of an Agile team dedicated to Claims Transaction data operations & initiatives. • Leads Data Governance collaborations with Payer stakeholders to document, define, maintain, and manage Claims Transaction data standards and assets. • Assesses and monitors data quality metrics, analyzing trends and proactively promoting remediation and preventive action efforts. • Partners with IT and business teams to ensure the use of best practices and compliance with data standards. • Provides consultative stewardship services to delivery and issue resolution teams, serving as subject matter expert as needed. • Provides guidance on development, usage, and inventory of technical assets. • Represents GBS Data Governance in enterprise workgroups and data steward communities of practice. Qualifications • Bachelor’s degree or higher • 5+ years professional work experience in: • Data Stewardship, Data Governance, Data Management and Data Quality practices • Healthcare Payer Claims Transactions and Revenue Cycle operations • Claims Transaction data standards and operations, including: • Patient check-in and registration • Eligibility verification • Medical coding – ICD-10, CPT, HCPCS, SNOMED CT - ASC X12N Implementation Guides • Claim submission • Claim processing • Claim payment • Claim reconciliation • Coordination of Benefits Apply Job!