HRP Configuration Lead

HRP Configuration Lead Experience:

• 12 years of relevant experience.

Location:

• Hybrid Morris Plains, NJ or Tampa, FL (Onsite once or twice a week).

Primary Skills:

• HealthRules Payer
• HealthRules Language
• HealthEdge

Secondary Skills:

• Agile, SAFe

What's in it for you?

As an HRP Configuration Lead, you will be part of an Agile team, contributing to the development of healthcare applications and implementing new features while ensuring adherence to best coding and development standards.

Responsibilities:

• Serve as a highly organized and detail-oriented leader with strong analytical, problem-solving, and prioritization skills.
• Manage multiple tasks in a fast-paced, deadline-driven environment, both independently and as part of a team.
• Exhibit excellent verbal and written communication skills, along with strong interpersonal abilities.
• Effectively present information and respond to questions from managers, clients, and other stakeholders.

Skill Requirements: Healthcare & IT Systems Expertise:

• Deep understanding of Healthcare Payer business functions and IT systems.
• Knowledge of US Healthcare Payer workstreams, including:
  • Claims Processing, Network & Pricing, Provider Management
  • Medical Management, Premium Billing & Payments, Member Enrollments, Benefits Management
  • HIPAA X12 transactions (837I/P/D, 834, 270/271, 835).
• Experience with various lines of business: Medicaid, Medicare, and Commercial insurance.
• Familiarity with industry standards and coding systems such as ICD-10, HCPCS, CPT, Revenue Codes, DRG, APC, and NDC.
• Expertise in Core Administrative Processing Systems (HealthRules, Facets, QNXT, etc.).

HealthRules Configuration & Implementation:

• Configure Benefit Plans, Network and Supplier Contracts (Pricing), Providers, Enrollments, Premium Accounts, and Sub-accounts within HealthRules.
• Collaborate with customers, internal stakeholders, and third-party vendors for requirements gathering, architecture design, development, testing, and implementation.
• Implement HealthRules as a claims adjudication system and integrate it into the existing application ecosystem.
• Architect, design, and deploy HealthEdge HRP components for claim administration.
• Integrate HealthRules API and Connector Services with required applications.
• Guide data profiling and data migration from legacy claims systems (e.g., Facets, Amisys, QNXT) to HealthRules.
• Maintain documentation of project deliverables and versioning.
• Mentor and guide teams on technology, frameworks, and best practices to ensure high-quality deliverables.
• Support testing and deployment of HRP solutions.
• Architect, design, code, test, and document moderate-to-high complexity interfaces based on requirements.

Educational Qualifications:

• Bachelor's degree in computer science, information technology, or a related field is highly preferred.

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