Dear Associates,
Hope you are doing great! *Please reply to **[email protected] <[email protected]> * This is Ali Ahmed from Exatech Inc. We have an immediate need for below mention requirement, if you feel that you are a perfect match to this requirement, please forward your most updated resume along with the best time and number to carry out further discussions. Looking forward to hear from you... *Role: Senior Program Manager* *Location: Glen Burnie, MD* *Duration: Long Term* *Rate: $/hr on C2C All Incl.* *Client Scenario:(this is must)* Here’s additional information about the role – anyone that worked on pharmacy claims (PBM – at CVS, ESI, Walgreens etc) will NOT be the best fit here. We need experience with - Core Claims Management, Eligibility Verification, Adjudication, Claims Administration/Tracking, Fraud & Abuse Auditing, Claims Payment, Revenue Cycle Management, Overpayment Recovery, Members Claims Database, Check Writing and EDI. We need a talent who has implemented the entire package/claims processing & payment platform……not bits and pieces of applications that support the said comprehensive platform. *Project:* Migration to a new vendor claims platform (which is a rules-based and plan configurable enterprise developed in Java/J2EE and includes features of all HIPAA standards) that will involve: Member Management, Group Admin, Eligibility/Enrollment, Premium Billing, Network Management, Provider Contracting, Provider reimbursement, Automated re-pricing, UM & MM, CM, EDI interfaces, Web Portals, Authorizations, Pre-Cert, Subrogation, Cust. Services etc. The Program Manager will work on behalf of client - both as a thought leader and hands-on implementation coordinator between client and vendor implementation team. Tasks shall include: o Systematically replace (without impacting the said payer services) the current claims platforms with new vendor platform. o Convert all the health plan (application) data from the exiting platforms via pre-defined APIs. o Ensure seamless integration and Data Exchange between the new vendor platform EDI gateway and the plan benefit administrator/s, CMS (and other Govt. Agencies), network providers and internal applications (using HL-7 norms). *Sr. Program Manager - Claims Implementation:* · This resource should have 10-15 years of progressive IT experience including in-depth experience with healthcare payers. · Claims platform deployment work experience. · Experience managing 2-3 implementations of healthcare payer claims software such as HealthRules or Facets. · Lead the tactical implementation of a healthcare claims processing software application. · Establish standards and practices within a multi-vendor environment. · Develop and Manage project plan to align varying workstreams to common go-live date. · Pro-actively identify conflict/integration issues and lead team members to parse and synthesize issues of highest complexity, including cost/benefit analysis and resource estimating. · Deliver executive reports and communication on project status. · Accurately estimate and plan resource usage. · Regularly review status of project and modify schedule as necessary. · Oversee and facilitate project team meetings and prepares status documents periodically throughout the project; this includes: Project Plan, Status Reports, Issues List. · Facilitate project planning sessions. · Effectively resolve roadblocks to project progress. · Influence the owner, sponsor, steering committee and other appropriate senior management. · Have accountability and shared responsibility (with software vendor) to set and drive toward the client specific deployment strategy, including governance model and reporting, model office environment. · Experience deploying and managing projects using agile techniques. · Healthcare Insurance operational knowledge with the ability to effectively communicate concepts related to clearinghouse, payment systems, EDI transactions, Health Insurance Exchange, Billing & Payment, Claims Processing, Sales & Enrollment, Quote to Card, Health Management; operational experience working for a health plan preferred. *Preferred:* · PMP and CSM certifications. Regards *Ali Ahmed* *Exatech Inc* 4758 Forest Ridge Dr Mason OH 45040 Phone: 513-433-5531 Email: [email protected] Web: www.exatechinc.com -- You received this message because you are subscribed to the Google Groups "SAP ABAP" group. To unsubscribe from this group and stop receiving emails from it, send an email to [email protected]. To post to this group, send email to [email protected]. Visit this group at http://groups.google.com/group/sap-abap. For more options, visit https://groups.google.com/d/optout.
