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Consultant I

Consultant I

UST

14 years

0 Lacs

chennai tamil nadu india

Posted:1 week ago| Platform:

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Skills Required

healthcare consulting compliance processing membership enrollment transactions management risk assessment discovery analysis benchmarking development remediation traceability visio uml agile ui ux data database collaboration interoperability powerpoint word excel presentation certifications scrum research

Work Mode

On-site

Job Type

Full Time

Job Description

Role Description

Experience: 14+ YearsLocation: Chennai,Kochi,Trivandrum

Skills

Core Healthcare Domain Expertise

US Healthcare Payer & US Health Insurance domain
Commercial, Medicare, Medicaid, Duals, Exchanges (ACA)
Healthcare Industry Consulting & Healthcare IT
HIPAA compliance & Affordable Care Act (ACA)
Medicare & Medicaid regulations
Core Administration Systems
Claims Processing & Adjudication
Membership Enrollment & Eligibility
EDI Transactions (HIPAA X12 5010 – 834, 837, 835, 270/271)
Member Services & Provider Services (end-to-end)
Care Management, Risk Management, Quality Management

Consulting & Assessment Capabilities

Discovery & Assessment engagements
Current-state analysis (functional & technical landscapes)
Future-state definition & solution design
Industry best practices, benchmarking & gap analysis
Recommendation development & implementation roadmaps
Technical remediation planning
Statement of Work (SoW) documentation
Proposal solutioning (RFP/RFI/RFX – proactive & reactive)

Business Analysis Skills

Requirements elicitation, gathering & documentation
Requirements management & ownership
Joint Application Development (JAD) sessions
Requirements Traceability Matrices (RTMs)
Process modeling & documentation
MS Visio, UML diagrams, process flows
Waterfall & Agile methodologies

Product Ownership / Product Management (Good to Have)

Product roadmap development
Product backlog management
Epics & user stories
Healthcare UI/UX requirements
Healthcare data management & database needs
Cross-functional stakeholder collaboration

Technical & Interoperability Knowledge

Healthcare IT systems & platforms
FHIR (good to have)
HL7 (working knowledge)
Healthcare data standards & interoperability

Tools & Productivity

Microsoft PowerPoint (advanced)
Microsoft Word & Excel (proficient)
Presentation development for executive & client audiences

Certifications (Preferred / Good To Have)

AHIP / AHM Certifications (PAHM, FAHM, AHM)
Business Analysis Certifications (IIBA – ECBA, CBAP)
Certified Scrum Product Owner (CSPO)
Healthcare-specific certifications

Skills

US Healthcare Payer,US Health Insurance,US Healthcare, Consulting,Claims,Payer, Presales/Market research

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