Cosmos Analyst

Understanding of US Healthcare Payor workstreams including Claims Network and Pricing Provider Management Medical Management Premium Billing and Payment Member Enrolments Benefits Management.

Wellversed 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.).

Work with provider contracting staff when new/modified reimbursement contracts are needed.

Interacting with customers internal stakeholders and other thirdparty vendors for requirements gathering architecture and design discussions development testing and other activities.

Perform preadjudication claims reviews to ensure proper coding was used.

Communicate and/or collaborate with internal business partners to identify process improvement opportunities.

Mentor and guide the team on technology frameworks and processes and ensure quality of deliverables. Support testing and deployment of COSMOS.

COSMOS/UNET/NICE