Application Specialist – Healthcare Insurance Systems (Billing)

• Assist in the configuration, maintenance, and troubleshooting of RCM, Billing, and Insurance systems to ensure compliance operational requirements.
  
• Support billing rules setup, corporate accounts, exemptions, markups, and pre-authorization workflows as per health insurance standards.
  
• Provide support for claims lifecycle processes, including eligibility checks, pre-authorizations, billing, coding, claim submissions, and remittance processing.
  
• Support the integration of insurance data with internal EMR and financial systems, with a focus on Cerner workflows.
  
• Collaborate with Finance and Insurance teams to document business requirements and assist in translating them into system workflows.
  
• Prepare and execute test cases for System Testing, User Acceptance Testing (UAT), Unit Testing (UT), and Functional Testing (FT), focusing on system functionality and compliance.
  
• Provide end-user training and support, including the development of training materials for system functionalities related to insurance workflows.
  
• Assist in data migration tasks, including preparing data migration templates and data collection worksheets to ensure seamless system transitions.
  
• Perform Master Data Mapping for insurance-related workflows, ensuring data consistency across systems.
  
• Participate in system upgrades, patches, and testing cycles to ensure optimal system performance.
  
• Prepare functional documentation, including SOW, workflows, and best practice.
  
• Provide on-site and remote support during go-live and post-go-live phases to ensure operational stability.
  
• Willingness to work in shifts to support critical project and operational needs
  

Requirements

• Bachelor's degree in Information Technology, Healthcare Informatics, Business Administration or a related field.
  
• 6+ years of experience in healthcare IT, particularly in RCM, Billing, and Insurance systems.
  
• Expert understanding of claims management processes, including eligibility verification, pre-authorizations, and remittances.
  
• Hands-on experience with EMR/EHR platforms (e.g., Cerner, Epic, Oracle Health or equivalent EMR) and their insurance workflows.
  
• Proficiency in Microsoft Visio for process documentation and workflow design.
  

• Strong understanding of billing and insurance workflows, including Fee for Service, DRG (Diagnosis-Related Groups), and insurance agreements.
  
• Ability to troubleshoot technical system issues and support end-users in resolving functional problems.
  
• Strong analytical and documentation skills for tracking system performance and reporting issues.
  
• Understanding of HL7 messaging formats and ability to validate insurance-related transactions.
  
• Flexibility to work in shifts to provide necessary system support.