Job Description

Title: Business Consultant – HealthRules Payor

Location: 100% Remote

Position Overview:

Reporting to the Manager of Business Services Consulting, the Business Consultant will play a pivotal role in driving the successful implementation and optimization of healthcare claims software solutions for our clients. This role requires a deep understanding of healthcare claims processes, strong project organization skills, and relationship management skills. The ideal candidate will have a proven track record of delivering mid-to-complex software projects, accurately forecasting and scheduling business deliverables to meet project timelines.

The Business Consultant engages in high-level client-facing consulting and is responsible for the delivery of business tasks associated with the implementation and support of the HealthRules products. This includes supporting the Value Stream Lead in client discovery sessions and design workshops to tailor solutions to customer needs. This role assists the value stream lead in triaging implementation issues, evaluating process quality and defining standards, forecasting and scheduling the business deliverables, and testing requirements. The Business Consultant will partner with Value Stream Lead to complete tasks assigned to support the implementation.

• Key Responsibilities:Project Support for Consultants: Support the end-to-end healthcare claims software implementation projects, within assigned Value Stream, ensuring alignment with client objectives and timelines. Collaborate with other team members within the assigned value stream.
• Client Engagement: Engaging with clients, to build strong relationships and ensuring client satisfaction within the assigned responsibilities.
• Solution Design: Collaborate with clients to understand their needs and support the design of tailored software solutions that meet their business requirements within the assigned Value Stream. This involves configuration of HealthRules Payor and related solutions.
• Risk Management: Identify potential project risks and develop mitigation strategies to ensure project success. Proactively monitor risks throughout the project to ensure successful outcomes.
• Quality Assurance: Ensure that all deliverables meet the highest standards of quality and compliance with industry regulations.
• Continuous Improvement: Stay current with healthcare industry trends and best practices, continuously seeking opportunities to improve our implementation processes.

Responsibilities:

• Customer consultation Support the assessment of the client's current business requirements, based on the value streams, Plan Management, Provider Management, Member Management, Claims Management, Customer Service, and User Security.
• Coordinate and lead activities with customers, third-party vendors, and Client internal stakeholders as directed in the assigned Value Stream
• Consult on optimization and troubleshooting HealthRules Payer functionality
• Aid clients with capturing defects, performing initial triage, tracking and re-testing remediation
• Be prescriptive in consultation of recommendations in requirements and solutions, while always maintaining a customer-centric mentality

• Knowledge and thought leader in Consulting Services Subject Matter Expert in (1) Value Stream
• Participates in process optimization efforts within the Consulting Services organization and in assigned Value Streams.
• Familiarize and adhere to the role-specific documentation and training materials in support of Value Stream initiatives
• Perform all job functions consistent with Client policies and procedures, including those which govern the handling of PHI and PII
• Familiarize and adhere to playbooks

• Execution of Business tasks Responsible for identifying functional gaps within HealthRules Payer Suite.
• Support the customer in creation of requirement documents needed when they are requesting an enhancement or new feature

• Business Project Management Digital Planner, timelines and estimates for Business tasks within the implementation statement of work for the assigned Value Stream
• Maintain delivery timeline and quality attributes using approved processing tools
• Oversees Business backlog, including issues and requirements, within assigned Value Stream
• Leads completion of the Business transition to support artifacts for their assigned Value Stream
• Other duties as assigned

• What You Bring: Bachelor's degree in related field
• 5 years of experience in a customer-facing, business consulting/product implementation/ business analysis role.
• 5 years prior health plan industry (HMO, PPO, POS, MAPD, Medicare, Medicaid, Dental etc.) experience
• 5 years prior Business Consulting/Analyst experience
• 5 years prior ITS/BlueCard experience a plus
• Experience with Health Plan Claims and Benefits administration Software
• Excellent written and verbal communications skills
• Ability to remain calm in challenging situations
• Ability to work in a fast-paced environment
• Ability to communicate change within a project
• hands-on experience using HealthRules Payer Suite Prior experience with Health Plan core system implementation
• Ability to work under pressure, react and manage change
• Manage Conflict and facilitate resolution to client issues
• Dealing with ambiguity while guiding customers

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