Job Description
12 -15+ years of experience as a Lead Consultant/Business Architect/Program Manager/ Product Manager with Healthcare Payer domain.
Excellent Communication Skill and managing client stakeholders
Experience in creating Business solutions . Worked on consulting presales activities
Experience in executing Consulting Assessment programs
Ability Gather, analyse, and document business and technical requirements for healthcare Programs
Experience on core business applications in Enrolment, Claims. Payment areas (Facets, QNXT , NASCO etc )
Knowledge of CMS rating standards (STAR) and quality measures reporting
Ability to Interpret and map HIPAA X12 EDI transaction sets (e.g., 270/271, 837, 835, 999) to system data models and ITX transformations.
Conduct gap analysis, impact analysis, and facilitate design walkthroughs with business and technical teams.
Coordinate across cross-functional teams (product, ops, compliance, providers) to ensure integration requirements are met.
