VDart Inc
2 to 4 Year(s)
7+ years of experience working in an operations role at a health plan4+ years of Healthcare experience in any of the following:Government Programs, PBM, Clinical Health Management, Core Administer Delivery, Program Management, Product Management, or Network Management2+ years of experience in one or more of the following:Operational business process improvement, business process analysis, benchmark analysis or workflow analysisAbility to work on claims with different LOBs such as Commercial, Medicare, Medicaid etc.Knowledge and experience of Medicare & Medicaid state level reporting levelsStrong Knowledge/Experience with Dimensional ModelingStrong understanding of healthcare data formats, standards, and can map them to CMS and state level reporting needsGood understanding on the lifecycle of claims adjudicationPossess good exposure on the various claim functionalities such as Edits, COBs, claims adjustments, Episodes etc.