RIT Solutions, Inc.
Include Job Summary:
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.
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.