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Job Location | Chennai |
Education | Not Mentioned |
Salary | Not Disclosed |
Industry | IT - Software |
Functional Area | General / Other Software |
EmploymentType | Full-time |
Job DescriptionNclexCertification compulsory ValidUS active RN licenseBroad clinical experience (must be Western Medicine, would prefer nursing experience in the US)3-5 years of auditing experienceStrong communication skills both written and verbalComputer literate (MS, Word, Excel, Access)Strong personal and professional ethicsBachelors Degree in Nursing preferredRisk adjustment experience preferredSome ICD-9/ ICD-10/ CPT coding experience preferred (does not need to be a CPC)Strong written and oral communication skillsStrong Business Analysis skills Business Requirement documentation, Functional Specification documentation, User Acceptance Testing, Business Process Flow, Gap AnalysisMust have a strong analytical, problem-identification and process analysis skills with the ability to envision a solution from requirementsCreation of suitable documents (e.g. BRD) for the program developmentEnsuring technical feasibility by coordinating with the technical teams.Review of various programs to ensure that requirements are translated correctlyDesign and execute test plans on computer applications.Record and document results and compare to expected results.Detect software failures so that defects may be discovered and corrected.Generate historical analysis of test results.Document anomalies and issues.Good knowledge in US health care and reimbursement guidelines. Preferably having good understanding on Pharmacy and Medical Claims management as part of Reimbursement OptimizationExcellent communication and documentation skills.Requires experience with software / data quality assurance.Requires Structure Query Language (SQL) experience.Working within the timelines and getting necessary sign-off on each stages of work from stakeholders.Work independently and as a team.Liaison with the program/ project manager as required.Good team player & collaborative in approach.Conduct all job functions and responsibilities in accordance with all company Compliance, Information Security and Regulatory policies, procedures and programs.,
Keyskills :
useracceptancetesting processflow dataquality businessprocess processanalysis businessanalysis claimsmanagement trongcommunicationskills cptcoding ushealthcare useracceptance computerliterate coding