Description : Responsibilities :
Responsibilities :
- Collaborate with cross-functional teams to understand healthcare business requirements and translate them into technical specifications
- Provide domain expertise to inform the design, development, and implementation of IT solutions tailored to the healthcare industry.
- Conduct thorough analysis of existing healthcare workflows and systems to identify areas for improvement and optimization.
- Act as a liaison between healthcare stakeholders and IT teams to facilitate effective communication and alignment of objectives.
- Stay updated on industry trends, regulations, and best practices within the healthcare domain to inform strategic decision-making.
- Lead training sessions and workshops to educate stakeholders on new IT solutions and ensure successful adoption within the healthcare environment.
- Identifies opportunities to enhance assets that deliver operational efficiencies to the business and leads its implementation
- Understands issues facing the business that would affect digital assets / core systems and peripherals and develop strategic solutions for implementation
Qualifications :
- Experience in cross-functional solution architecture and development, focused on delivering high-quality IT solutions for health Insurance players like Humana, Aetna, Cigna etc.
- In-depth Knowledge of Healthcare Insurance and systems. This includes familiarity with various types of insurance plans (e.
g., HMOs, PPOs, Medicare, Medicaid) and their respective requirements.
- Proficiency in healthcare insurance concepts like member enrollment, claims processing, denial management, care management, medical management and clinical support
- Understanding of Healthcare Regulations such as HIPAA, ACA, and state-specific insurance regulations. This includes staying updated on regulatory changes and ensuring compliance with industry standards.
- Experience / knowledge of interoperability standards, such as HL7 C-CDA and FHIR
- Experience with clinical concepts, such as SNOMED-CT, ICD10, CPT and RXNORM
- Stakeholder Management : Strong interpersonal skills and the ability to communicate effectively with internal teams, external partners, and policyholders
- Ability to address complex challenges and make data-driven decisions to optimize healthcare insurance operations.
- Experience in responding RFIs and RFPs
- Staying updated on industry trends, emerging technologies, and best practices in healthcare insurance.
Good to Have-
- Minimum of 8 years of experience working in the healthcare industry, with a deep understanding of healthcare processes, regulations, and challenges.
- Experience in developing strategies to improve efficiency, reduce costs, and enhance the quality of insurance services is valuable.
- Strong analytical and problem-solving skills, with the ability to assess complex healthcare scenarios and propose innovative technology-driven solutions.
- Certification in relevant healthcare IT systems (e.g., Epic, Cerner, Meditech) is a plus.
- Familiarity with Agile methodologies and project management principles is desirable. Excellent collaboration, influencing, and consensus-building skills.
Ability to work with persons in all job functions (e.g. product, program, developers, etc).
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