Business Process SME - Provider Data Management

Lorven Technologies Inc.

Hi Professional,

Our client is looking for Business Process SME – Provider Data Management project in East Brunswick, NJ below is the detailed requirements.

Job Title : Business Process SME – Provider Data Management

Location : East Brunswick, NJ

Duration : Long Term

Description:

Bachelor's degree or Master’s Degree in Computer science, or a related field, with minimum 12+ years of experience.
15+ years of experience in Healthcare Payer Operations, with 10+ years in Provider Data Management.
Strong expertise in end-to-end provider lifecycle and provider data governance.
Good Experience managing provider onboarding, setup, maintenance, termination, and directory updates.
Must be Expertise in credentialing, recredentialing, PSV, sanction monitoring, and NCQA/CMS compliance.
Strong knowledge of provider contracting, network management, and provider roster management.
You should have Experience with FFS, capitation, Value-Based Care, shared savings, and risk-sharing models.
Good Knowledge of provider pricing configuration, fee schedules, rate loading, and reimbursement.
Must have a Experience analyzing provider contract impacts on claims adjudication and payment accuracy.
You should be Skilled in requirements gathering, process mapping, SOPs, business process reengineering, and stakeholder management.
Experience with Facets Provider Module, UHC/Optum, NDB, NICE, Salesforce, or similar platforms is preferred.

With Regards

Rajkumar,

Lorven Technologies, Inc.

101 Morgan Lane | Suite 209 | Plainsboro | NJ 08536

Tel: -View phone number on click.appcast.io * 247 | Fax:View phone number on click.appcast.io

Email: View email address on click.appcast.io| Web:

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Vacancy posted 18 hours ago

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