Urgent Need ! Business Operation Engineer in Boston, MA

Hi BusinessPartners,

Hope you are doing great!

Please find below mentioned job description and revert back with the updated resume to 

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lucky@itstrategiesinc.com

Job Title: Business Operation Engineer

Location: Boston MA

Duration: 3+ Months

Interview Process: TBD

Required Skills:

·         Worked at a health plan in a kay operational area (billing, UM, CM, claims, etc.) 3-5 years 

·         Consulting experience preferred over Business Analyst experience 

·         Operational engineering/process engineering or background in instructional design

·         NO requirement gathering or getting BRDs

·         Large system implementation 

·         Education, College

·         Masters nice to have 

·         System experience in HealthRules

Project Background:

Client is currently in the process of implementing HealthRules. 

Client currently has three lines of business: (Commercial, Medicaid and Medicare). Each operates on a different core administrative platform.

The Medicaid line of business, acquired through acquisition and operating on Monument Express, is going to be the first to migrate it's 350,000+ members to move over to HealthRules.

The goal will be to migrate Medicare (currently on a Diamond product) and Commercial (currently on a homegrown platform) to the same platform eventually for uniformity.

Operational readiness for migrating THP's Medicaid line from Monument Express to Health Rules. THP hasn't put a plan in place for the consequences & risks for the go live. This project will help minimize the risks for go live.

 

Consultant Responsibilities:

Documentation of Policies and Procedures 

Process Testing 

Metrics Collection and Monitoring 

Creation of Job Aids and Desk Level procedures for sub-set of functional 

Creation of Go-Live deployment readiness checklists and plans 

Care Management (including Utilization Management and Disease Management) 

Claims 

Credentialing 

Customer Services 

Enrollment/Membership 

Finance (includes Billing) 

Pricing 

Provider/ Network Management 

Additional areas will be evaluated, specifically from a hand-off perspective, for inclusion: 

Compliance 

Grievance/Appeals 

Risk Management

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Thanks & Regards
Lucky Pawar
Sr Technical Recruiter
Integrated Technology Strategies, Inc.
Direct: 856 519-0049

​​

lucky@itstrategiesinc.com | www.itstrategiesinc.com
Yahoo/Gtalk IM : laxmikanthpawar

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