commercial, federal and state government plans specifically support operational
processes for provider data management functions, enrollment and eligibility,
member benefits, claims adjudication and EDI Interfaces functions.
• Knowledge of State regulations to determine provider meets qualification to be
enrolled.
• Knowledge of provider files from State Medicaid programs to decipher provider
enrollment and eligibility rules.
• Knowledge of provider type designation identified by the State Medicaid programs.
• Knowledge of provider and member portal functions.
• Knowledge of provider reimbursement methodologies about Commercial, CMS and
State defined guidelines.
• Knowledge of provider matching criteria for claims.
• Knowledge of Coordination of Benefits (COB) and Claim Authorizations functions.
• Knowledge of Setting up communications for EDI transmissions using FTP, SFTP and
real time API setups
• Knowledge of health insurance, HMO and managed care principles including
Medicaid and Medicare regulation.
• Solid analytical skills with the ability to compile data from many sources and define
designs for enrollment to benefit plan configuration.
• Research, interpret and summarize new state, federal and client rules regarding
department functions. Alter or create policies and procedures to adhere to those
rules.
• Solid communication skills with working session facilitation.
• Strong time management, attention to detail, analytic and organizational skills.
• Excellent interpersonal, oral and written communication skills.
• Able to work independently and within a collaborative team environment with little
guidance/supervision.
Shubham Vishwakarma
Full Stack Developer - Averlon
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Application : https://forms.gle/5Vn7YXzyXx9muoEZA
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We are a team of IIT Bombay and IIT Kanpur graduates with over 10 years of experience in building SaaS products. Our software product is used by finance and accounting professionals. We are looking for a self-motivated, passionate content writer who understands SEO and is a fast learner. This role offers the chance to drive web traffic through SEO, content, and analytics.
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Full Stack Developer - Averlon