Key Facts

Remote From:

Full time

English

Hard Skills

Payment Systems Solution Architecture Auditing Pricing Analytics Cloud Computing Payment Plan Agreements Billing Provider Model Financial Management Stakeholder Communications

Other Skills

•
Coordinating
•
Mechanical Aptitude

Roles & Responsibilities

Healthcare/claims knowledge
Experience with provider payment integrity, policy and pricing
Proficiency with billing tools and editors (e.g., ClaimsXtend, Claris-like tools)
US Citizenship or GC with EAD

Requirements:

Align solution architecture with provider payment integrity, policy and pricing in healthcare/claims
Participate in claim auditing processes and ensure proper payment
Collaborate with Care Nav, Provider Ops, and Provider Financial Management to support payment integrity workflows
Assess and coordinate tooling evolution (replacing Claris, migrating ClaimsXtend to cloud, Cotiviti secondary editor; evaluate potential new pricing tool; NASCO as claims payment system/vendor)

Georgia IT, Inc.

About Georgia IT, Inc.

Georgia IT, Inc. provides IT Consulting for a wide range of IT services and custom build turn-key enterprise solutions. GIT specializes in improving business scalability and efficiency through BSM and SBA Solutions. GIT transforms business with service management and service automation solutions. We are BMC & HP partners. GIT Services include custom built enterprise software and customer-centric web portals, network design and implementation, remote and site-to-site VPN, network and server security assessment and setup, server and desktop virtualization, and many others. GIT also provides IT Consulting in many areas such as Disaster Recovery Planning, Enterprise Data Backup Strategy, Long Term Strategic IT Planning and Augmentation Professional Services Solutions. Professional Services Specialties: Business Process Integration, Software Integration & Development, Web portal, Networking, Remote and site-to-site VPN, Virtualization Solutions, Product Development Please contact us Hrus@georgiait.com / uthay@georgiait.com/470-798-5000 x 1010 / (732) 890-2535 direct

Founded: 2018

Company size: 51 - 200

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Job description

Solution Architect
Duration until June
CTH -100% remote
US Citizen / GC and GC EAD

Solution Architect with healthcare/claims knowledge

Provider payment integrity, policy and pricing
Will be part of a claim auditing process
Ensure proper payment
Savvy with various tools
1 core set of stakeholders they'll work with
Care Nav
Provider Ops
Provider Financial Management
Provider payment integrity, policy and pricing --- this is the group where the Solution Architect will sit
Replacing Claris coordinating billing tool
ClaimsXtend (editor) migrating to the cloud
Cotiviti Secondary editor they use
Potentially bringing in a new pricing tool
NASCO = claims payment system/vendor