Claims Operations - Prospective Payment Software (PPS) Analyst
Company: Ciber Global
Location: Minnetonka
Posted on: January 9, 2021
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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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