RIT Solutions, Inc.
Include Job Summary:
Expected skillset:
Nice to have:
Expected skillset:
- Experience working on any state APCD (All Payer All Claims) process is preferred.
- Exposure to risk adjustment, Kick payment processes will be added advantage.
- SQL, SAS reporting and Power BI skills will be preferred as well.
- Strong working knowledge of health care EDI transactions. (837 I/P/D, Response transactions - 835, 277U, 999, TA1, 834 etc.)
- Previous working experience implementing any Marketplace/Medicaid / MMP Markets.
- Proficient in validating data generated internally and submitted by vendors to perform Quality Assurance prior to sending data to state.
- Working experience handling vendors and guiding them on encounters aspects.
- Ability to review state documentation and come up with recommendations to implement solution engaging with our internal IT, cross-functional teams.
- Experience handling vendor / state calls to represent CareSource and provide project status updates.
- Proficient in running SQL queries to assist in SQA (testing) efforts, create summary reports and being able to manually create X12 data to assisting testing / proof of concept validation.
- Knowledge of CMS / state Medicaid programs and ability to comprehend 5010 837 Implementation Guide and state companion guides.
Nice to have:
- Prior experience working in Marketplace submissions will be a plus.
- Previous working experience in extracting data from Enterprise Data Warehouse and providing requirements / validation on EDW data is a plus.
- Understanding state SLA's and experience in creating dashboard reports for different State SLA's (Service Level Agreements - Accuracy, Completeness, Timeliness), Throughput reports is a plus.
- Previous working experience managing NCPDP transactions is a plus but not mandatory.
- Knowledge of FACETS / similar claim adjudication system.
- Knowledge of EDIFECS Encounter Management system.