
Senior Business Consultant with Healthcare Solutions
4 days ago
Gather, analyze, and document business requirements related to HIPAA, CMS, NCQA, and state-specific regulations.
Key Responsibilities:- Ensure system changes, processes, and documentation remain compliant with healthcare regulations and payer guidelines.
- Act as liaison with compliance and legal teams during audits or regulatory updates.
- Benefit Codes & Plan Configuration
- Analyze and configure benefit codes for medical, dental, pharmacy, and specialty products.
- Support plan design, benefit mapping, and validation in healthcare systems (e.g., Facets, QNXT, or other payer platforms).
- Collaborate with product and IT teams to ensure accurate coding, claims adjudication, and eligibility processing.
Strong understanding of healthcare regulations, including HIPAA, CMS, NCQA, and state-specific guidelines.
Excellent analytical and problem-solving skills.
Ability to communicate effectively with cross-functional teams.
BenefitsCollaborative work environment.
Opportunities for professional growth and development.
OthersCoordinate development and validation of member-facing collateral such as Explanation of Benefits (EOBs), Summary of Benefits and Coverage (SBCs), provider directories, and plan brochures.
Partner with marketing and compliance teams to ensure content accuracy, regulatory alignment, and timely delivery.
Track versioning and approvals of collateral to maintain consistency across all distribution channels.
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