Macess EXP Consultant Job in Multiple Cities 76227, California US
Qualifications
· Significant workflow consulting experience utilizing leading workflow solutions in the health care industry such as MACESS or PegaSystems
· Consulting experience in or direct exposure to the following:
§ Health Insurance Claims Processing including Intake, Pre-processing, Claims Adjudication, Exception Processing, Audit/Review, Finalization and Payment
§ Operations Analysis and Business Process Improvement: Process Evaluation and Measurement; Process Re-design; Health Plan Operations Assessment/Review and Improvement Plans; Medical Management Design and Improvement; Regulatory Compliance and Audit Preparedness; Revenue Cycle Design
§ Information Technology: Workflow system load balancing, user/customer support, upgrade management, disaster recovery planning, system administration
· Highly articulate, with excellent verbal, written, and presentation skills
· Project management experience in both large and small project settings
· Other relevant experience in payer and/or provider operations:
§ Provider: Revenue Cycle, Patient Business Services, Practice Management, Clinical Operations, Finance
§ Payer: Group/Member Administration, Enrollment, Claims Processing, Provider/Network Management, Care/Medical/Disease/Utilization Management, Member Services, Call Centers, Finance
· Bachelor’s degree
· Prior Experience: 4 - 10 years of professional experience, with at least 5 years of experience workflow consulting utilizing industry leading workflow tools
· Travel: Ability to travel 75% required
RELOCATION IS OPTIONAL. Client will assist with relocation expenses.