Client: Healthcare domain
Position: HealthRules Payor
Location: Hybrid in Philadelphia, PA- locals or nearby only
Pay rate: $75/hr hour C2C
Exp level: 14+ years
HRP is HealthRules Payor
HPR Configuration is the KEY
Resource to support our new MA PPO buildout and the ACA Exchange
Consulting Services to:
Provide business optimization on the following areas:
Provider contracting and claim pricing
Claims workflow and auto-adjudication
Manual processes in place to address high Claim Review and Repair Workbasket volumes
Research contract configuration, claim adjudication results, HCC setup and policies and make potential recommendations on configuration changes to increase auto adjudication and reduce administrative cost where possible.
Reevaluate HealthRules Payor configuration:
To reduce manual work involved with new or renewed provider contract configuration
To increase auto-adjudication, with particular attention to the Provider contracting issues
To reduce manual work and pended claims volume, particularly for Supplier Location and Practitioner Role matching issues
To optimize claims operations in other manners
To pay Providers accurately and on a timely basis