Claims Solution Consultant - Healthcare IT

Description

As the world's largest healthcare services company with more than $100 billion in annual sales, McKesson Corporation (McKesson) is a Fortune 15 Corporation that provides pharmaceutical supply management and information technologies across the entire continuum of healthcare.

McKesson Health Solutions delivers market-leading solutions that drive clinical and business intelligence into every healthcare decision to help payors and providers optimize the quality and cost of care. Our clinical and technology tools and experts help clients validate appropriateness of healthcare services, automate authorizations, manage advanced diagnostics utilization, manage chronic disease, optimize claims payment decisions, and harness the transformative power of analytics. We achieve these results through five major product lines: innovative solutions including auto-authorization tools from Advanced Diagnostics Management; business intelligence solutions from the Care Management software product line; market-leading code audit solutions from the Claims Performance product line; the industry-leading InterQual® criteria for evidence-based clinical decision support; and whole-person Care Management services for chronic disease management and nurse triage.

Current Need

Claims Solutions Consultant - Healthcare IT

Position Description

The Claims Solutions Consultant (CSC) is responsible for understanding the client¿s claims environment, payment policies and supporting the client by responding to inquiries and issues. Assist in determining and developing how services and rules engine should be implemented within the client¿s environment.

The CSC is responsible for development of technical specifications and use cases (test scenarios) related to a client¿s claims environment and payment policies as described in requirement documents delivered to them by implementation and support teams. Assist in determining how rules should be implemented within the client¿s environment.

The CSC works effectively on their own, receiving direction and assignments from the Solution Consulting Manager, or with assistance from implementation team members, particularly the Claims Solutions Lead and Business Analyst.

Key Accountabilities

The Claims Solution Analyst will be accountable for the following key success factors:

Design and specification of intelligent rules based on the Rule Configuration

Criteria Questionnaire and other solution design requirement documentation, and using standard tools, including the Dictionary Configurator.

Development of use case scenarios for the rules using the Test Scenario Generator application

Documentation of all Rule specification changes, and participation in peer review sessions of rule specifications developed by other CSAs

Investigation and resolution of rule-related support tickets received by MHS Support

Additional Knowledge & Skills

Works on problems of diverse scope where analysis of data requires evaluation of identifiable factors. Exercises judgment within generally defined practices and policies in selecting methods and techniques for obtaining solutions.

Thorough knowledge of company products, company functions, marketing and/or service policies and procedures, PC, and excellent communication and telephone skills

Minimum Requirements

5+ years of experience in a service-oriented preferably a healthcare claims operation organization.

Excellent communication skills both written and verbal

Demonstrated experience in critical thinking and problem solving skills

Education

4-year degree or equivalent experience in customer support

Physical Requirements

General Office Demands

Company Statement

McKesson offers a competitive compensation and benefits package.

McKesson is everywhere in healthcare. We offer a wealth of opportunity for individuals with a desire to make a difference in providing industry-leading, integrated healthcare services and solutions. Individuals with the passion to be a part of our entire continuum of patient-focused care. It's you and McKesson - empowering healthcare. Visit www.mckesson.com/careers for more information.

As an equal opportunity employer, McKesson Corporation unites the talents and contributions of all to advance the power of healthcare.

Agency Statement

No agencies please.

The material contained herein is provided for informational purpose only. All open jobs offered by McKesson Corp. on this recruitment system are subject to specific job skill requirements. The job skill requirements, qualifications, and preferred experience are determined by a subsidiary, office or department within the company which is offering the position, and all positions are subject to local prevailing employment laws and restrictions. This would include immigration laws pertaining to work authorization requirements and any other applicable government permissions or compliance.
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