- Understanding of US Healthcare Payor workstreams including Claims Network and Pricing Provider Management Medical Management Premium Billing and Payment Member Enrollments Benefits Management.
- Well versed with various lines of business specifically Medicare .
- Healthcare industry standards and codes usage ICD10 HCPCS CPT Revenue Codes DRG APC and NDC .
- Experience with COSMOS/UNET/NICE
- COSMOS Configuration: Set up of Benefit Plan Network and Supplier Contracts (Pricing) Providers Enrollment Premium and Account subaccounts etc. Review interpret and/or verify contract language information and intent to load information into systems properly Ensure contract templates can be administered across operations (pricing config claims etc.)
ICD10, HCPCS, CPT,,COSMOS