Immediate Fulltime/Direct hire with our client, who is responsible for a health insurance plans provided to their Union Membership nationwide. They are seeking a McKesson ClaimsXten (formally ClaimCheck) support specialist with hands-on configuration experience including; coding, working in the Wizard\Voyager OR alternatively technical support of CES from Optum. This is for professional/provider claims not the individual. The McKesson ClaimsXten Support specialist will join our clients Applications Development Department and will be responsible for supporting and enhancing the code auditing application to include the maintenance of codes, knowledge-bases, rules and all other appropriate updates. Primary Accountabilities Include:
Review, analyze and recommend coding approaches to minimize denials and pends but to ensure accurate payment for the provider.
Build, maintain and/or enhance code sets and knowledgebases.
Investigate requests by business customers for new and\or changes to existing system setup as well as conduct testing of code, rule and knowledgebase changes and enhancements.
Coordinate with Applications Development and Support manager and/or Team Lead, Applications Development to assure priority of new work (Governance).
Development or enhancements of reports to quantify the savings of the auditing.
Coordinate with the testing team for acceptance testing of changes and enhancements.
Other duties as assigned.
*About the Client**
Mid-sized stable organization offering longevity and stability. They are part of a National Union responsible for the Health Insurance Plan provided to the Union Membership. The organization is a preferred provider organization (PPO) committed to innovation in the Health Plan space. The organization offers a competitive salary and benefits package that includes a Pension. In addition the benefits include, PTOs, 11 holidays, tuition, pension, 401K, LTD, life insurance, health/dental and vision insurance.
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(1) 5+ years IT Technical Support, supporting Healthcare Applications
(2) 5+ years healthcare claims payment solutions
(3) Hands-on Configuration of McKesson ClaimsXten (formally ClaimCheck) including; coding, working in the Wizard\Voyager, setting up user defined edits (UDEs), and working with Policy Admin Module (PAM). Alternatively will accept same experience with CES from Optum
(4) Knowledge of QNXT claims processing system is preferred, not mandatory. The tool is integrated with QNXT
(5) CPC or CCA Certifications preferred
(6) Thorough understanding of claims processing from an operational and systems point of view.
(7) B.S. degree preferred, but direct experience may be substituted.
Glen Burnie, MD
Sunday, April 19, 2020
Monday, March 22, 2021
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