Job ID: 10086

  • Dec 28, 2020
  • Picadilly Star - Bonifacio Global City

The Payment Accuracy Advisor (PAA) role functions to implement and maintain the ClaimsXten Select (CXT) Rules and Rule Logic for customers’ use. As such, the PAA is assigned customers, as part of the Services Delivery Team, to understand the customers’ claim system(s), payment policies, and integration data elements managed using CXT for total payment accuracy, to carryout actions and activities such as:

  • Consulting, gathering, and documenting intent and technical requirements for rules and non-rule work
  • Triage, troubleshooting, and problem-solving for rule and non-rule issues reported during implementation and upgrade projects, Go Live, and post Go Live production support
  • Guiding customers thru impacts for routine CXT content and rule updates
  • Estimating level of effort for new or existing rule work for forecasting and/or pricing
  • Confirmation of milestone completions by supporting works to trigger customer invoicing
  • Collaborating with Sr PAA and Engagement Managers for planning and managing client works
  • Meeting and exceeding metrics such as utilization, time entry, forecasting, etc.
As a PAA, for rule and non-rule work, he/she will:

  • In conjunction with his/her assigned Service Delivery Team (i.e., including any off-shore resources) ensure high quality, on-time client deliveries.
  • Assert confidence and reliability as a trusted adviser to drive client facing initiatives through to conclusion.
  • Work on issues where analysis of situations or data requires an evaluation of intangibles.
  • Follows and maintains compliance with current methodologies, tools, procedures and processes. And in collaboration with Service Delivery Team members and supporting departments to ensure high quality work output and customer satisfaction. 

Responsibilities

  • Effectively work as customer-facing ClaimsXten Select rules development resource for successful client implementations, upgrades, and on-going production support use of the software. This will require consulting on rule development for customer intent, gathering and documenting technical requirements, troubleshooting rule behavior, testing rule functions, supporting QA testing, defect remediation, managing Pivotal (CRM), JIRA, CRB and other methodology processes, etc.
  • Effectively participate in ClaimsXten Select Service Delivery Team meetings, initiatives and metrics. Function as team member in support of all goals and objectives.
  • Effectively support internal special projects for the purposes of evaluating, improving, correcting, or newly implementing initiatives, objectives, new feature functions, defect remediations, etc.
  • Provide forecasting inputs for project works, supply requested metrics and attend all team meetings. Work with the Engagement Manager and Sr PAA to determine internal project milestones to drive client deliveries.

Minimum Requirements:

  • 4 – 8+ years of experience in health care combining first hand payor and consulting experience
  • 2 – 5 years of medical claims experience within payor environment required
  • SDLC exposure needed

Critical Skills

Customer’s Business

  • High level of expertise in payor environments and claims management
  • Granular understanding of different customer segments (national, strategic and/or specialized business)
  • High level understanding of claim architecture, infrastructure, and multiple platforms
  • Discusses customer issues (pains and trends) confidently with customers
  • Project deliverables coordination to ensure high quality rule readiness outcome, and milestone completions for customer invoicing

Clinical

  • High level of understanding of medical terminology, healthcare industry terminology and medical coding terminology
  • Must be able to articulate the clinical value of products and services provided to clients

Software Tools

  • High-level proficiency in the following software:
    • Word
    • PowerPoint
    • Excel
    • Visio

Additional Knowledge & Skills

  • Medical coding knowledge helpful

Communication

  • Confidently delivers presentations effectively to the customer
  • Confidently understand and articulate ClaimsXten Select rules development
  • Confidently conducts customer meetings/trainings efficiently and effectively

MicroSourcing offers diversity in career options. We welcome individuality in self-expression without losing the value for team involvement. We are a fresh look at the BPO & KPO industry. Come experience the MicroSourcing life and be part of our growing family.

Cultures and Values

We are a fast growing company but we have always been able to keep the fun, young and intimate atmosphere from the time we started. We strongly believe in transparency and honesty and we always make sure to represent the interests of our employees as much as we represent the interests of our clients.