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Claims Operations - Prospective Payment Software (PPS) Analyst

Company: Ciber Global
Location: Minnetonka
Posted on: January 9, 2021

Job Description:

Make a difference Ciber Global wants you. Come build new things with us and advance your career. At Ciber Global you'll collaborate with experts. You'll join successful teams contributing to our clients' success. You'll work side by side with our clients and have long-term opportunities to advance your career with the latest emerging technologies. Work Description: The Claims Operations and Payment Integrity Team is accountable for the Operating Model for the Prospective Payment Software (PPS) which includes grouper and pricing software. This Operating Model includes an end-to-end strategy for ongoing maintenance and ensure a consistent experience across software and platforms for both client and providers. The PPS Software Operations Analyst is a critical position within the organization and requires a broad and deep understanding of the complex payment methodologies that are the foundation to the software to ensure payment accuracy. The PPS Operations Software Analyst will work closely with IT, Configuration, Network, Quality, Training, Operations, Provider Finance and BTO to ensure bi-weekly software updates, testing and deployment are seamless and produce the desired outcomes. The PPS Software Operations Analyst is also responsible attending all PPS software vendor meetings, understanding upcoming changes and communicating these changes to client internal stakeholders and for developing status reports for tracking and reporting progress to ensure on-time delivery of scheduled software updates. The primary responsibilities include: Define, implement and manage the end-to-end operating model for on-going maintenance of Easygroup software. Primary point of contact for client related to PPS working sessions and meetings with our Vendor, this includes meeting coordination and taking learnings from meetings to share across client to identified stakeholders. Work daily with stakeholders across the organization to ensure bi-weekly updates, testing, signoff and communications are managed timely and desired outcomes are being met. Ensure alignment across stakeholders to develop, approve and manage quality plans, test cases, review outcomes and secure signoff. Provide PPS subject matter expertise, including complex payment methodologies that are foundational to the software and ensuring payment accuracy. Maintain an archive of changes, signoff and communications. Leadership for growth and maturity of the operating model as expansion of software is implemented to support client's growth and migration objectives. Provide feedback to all stakeholders for continuous improvement to the overall operating model. Create and report on the overall operating model through bi-weekly status reports and stakeholder communication. Proactively identify risks to the quality program. Requirements: 8-10 years of experience in a health payer organization related to SDLC, Operating Model development and management and complex payment methodology understanding. Multiple business segment knowledge a plus, including Medicare, Medicaid and Commercial products. Strong / broad understanding of claims adjudication, including pricing and grouper software. Strong / broad understanding of PPS complex payment methodologies. 3+ years of experience in a leadership or project management role. Experience with developing and implementing a standard process across multiple stakeholders. Team work. Partnership and collaboration in a matrixed role. Excellent leadership and group presentation, verbal and written communication skills. At Ciber Global our consultants have access to a comprehensive benefits package. Benefits can include Paid-Time-Off, Paid Holidays, 401K matching, Life and Accidental Death Insurance, Short & Long Term Disability Insurance, and a variety of other perks. Find a purpose Help clients embrace emerging technologies. Create inventive solutions and meet intriguing client challenges. Solve, fix, design and innovate. Be a part of something bigger by helping clients go digital, create engaging customer experiences and transform their business. Move ahead Our success as a company is built on practicing inclusion and embracing diversity. Ciber is committed to providing a work environment free from discrimination and harassment, where all employees are treated with respect and dignity. Together we work to create and maintain an environment where everyone feels valued, included, and respected. At Ciber, our differences are embraced and celebrated. Ciber Global is an Equal Opportunity Employer. We respect and seek to empower each individual and support the diverse cultures, perspectives, skills and experiences within our workforce. Ciber is proud to be recognized as a National Minority Supplier. National MBE Certification has been issued to Ciber Global, LLC by the Michigan Minority Supplier Development Council. About Ciber Founded in 1974, Ciber partners with organizations to develop technology strategies and solutions that deliver tangible business value. Ciber Global is a consulting, outsourcing and business solutions integration provider and partner with offices across the United States and India. Ciber's strength is enhanced by its parent company, HTC Global, a growing technology innovation and execution leader with 11,000 employees worldwide. HTC Global helps its clients reimagine technology to reach business goals.

Keywords: Ciber Global, Minnetonka , Claims Operations - Prospective Payment Software (PPS) Analyst, Professions , Minnetonka, Minnesota

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