Provide oversight and direction into developing standards for conducting insurance validations, making primacy decisions and performing recovery activities including policy and procedure, process, cross functional team interactions, and externally facing communications.
The Solution Manager works closely with multiple parties including sales, marketing, operations and IT management and will oversee the functional improvement and new feature set development of current and to be developed products and applications.
This professional will be responsible for supporting the company's payment integrity applications, database and reporting needs. Primary responsibilities will be to analyze, design, develop, implement and maintain technical solutions in AWS using data warehouse technologies, SQL Server 2016 with sharding, distributed cache solution, PostgreSQL, SSIS, and ETL solutions (Athena, HIVE, Hadoop clusters with Spark, Zeplin).
Perform legal research and interpret federal and state laws, regulations, interpretive guidelines, advisory opinions and court cases on various healthcare-related statutory and regulatory topics, particularly related to health insurance, health insurance reimbursement, managed healthcare, Medicaid, Medicare and HIPAA.