Job Description
Title: Medicare SME- Payment Integrity Analyst
Duration: 12 months
Location: Remote
Duration: 12 months
Location: Remote
- This resource will implement a process to test end-to-end common Medicare Advantage leakage scenarios across multiple Medicare service categories to rapidly determine whether any common issues are relevant at Client NC.
- TriZetto Facets configuration experience is required
- Collaborate with the team to establish rapid methods to identify current Configuration and payment leakage across key Medicare service categories, and define what is needed to remediate issues quickly across the inputs that support claims payment (medical policy, authorization, benefits, CMS rules, reimbursement policy, provider contracts, fee schedules)
- Support the following: Complete up-front end-to-end testing to identify leakage requiri...