Job
Description
At R Systems, you play a vital role in shaping the future of technology through designing cutting-edge software products, platforms, and digital experiences that foster business growth for our clients. Our product mindset combined with advanced engineering capabilities in Cloud, Data, AI, and Customer Experience enables us to provide innovative solutions to key players in the high-tech industry, including ISVs, SaaS, Internet companies, as well as organizations in telecom, media, healthcare, finance, and manufacturing. We take pride in being a Great Place To Work Certified company in 10 countries with a full-time workforce spanning India, the USA, Canada, Poland, Romania, Moldova, Indonesia, Singapore, Malaysia, and Thailand. As a Healthcare-SME, based in Noida/Pune with over 15 years of experience, your key responsibilities include: - Comprehensive understanding of private insurance models such as HMOs, PPOs, EPOs, POS plans, commercial insurance plans offered by employers or individual markets, dual eligibles, fee-for-service (FFS) models. - Good grasp of Quality Measurement and Metrics in Value-Based Care like HEDIS, NCQA, PCMH, MIPS, Risk-sharing Models such as HCC model for Medicare or CCM model for Medicaid. - Proficiency in Care Coordination models & Patient-Centered Care models. - Handling EDI formats for Eligibility, Pre-Authorization, 837P/I/D, 999, 276, 277, 835. - Expertise in Claims Lifecycle, managing Medical, Pharmacy, Dental, Vision, and Behavioral Health Claims. - Strong working knowledge of Coding Systems: ICD-10, CPT, HCPCS, Revenue Codes, and DRG coding for inpatient billing. - Skill in Claims Denial Management. Join us at R Systems to be part of a dynamic team that is revolutionizing technology and making a difference in the industry. At R Systems, you play a vital role in shaping the future of technology through designing cutting-edge software products, platforms, and digital experiences that foster business growth for our clients. Our product mindset combined with advanced engineering capabilities in Cloud, Data, AI, and Customer Experience enables us to provide innovative solutions to key players in the high-tech industry, including ISVs, SaaS, Internet companies, as well as organizations in telecom, media, healthcare, finance, and manufacturing. We take pride in being a Great Place To Work Certified company in 10 countries with a full-time workforce spanning India, the USA, Canada, Poland, Romania, Moldova, Indonesia, Singapore, Malaysia, and Thailand. As a Healthcare-SME, based in Noida/Pune with over 15 years of experience, your key responsibilities include: - Comprehensive understanding of private insurance models such as HMOs, PPOs, EPOs, POS plans, commercial insurance plans offered by employers or individual markets, dual eligibles, fee-for-service (FFS) models. - Good grasp of Quality Measurement and Metrics in Value-Based Care like HEDIS, NCQA, PCMH, MIPS, Risk-sharing Models such as HCC model for Medicare or CCM model for Medicaid. - Proficiency in Care Coordination models & Patient-Centered Care models. - Handling EDI formats for Eligibility, Pre-Authorization, 837P/I/D, 999, 276, 277, 835. - Expertise in Claims Lifecycle, managing Medical, Pharmacy, Dental, Vision, and Behavioral Health Claims. - Strong working knowledge of Coding Systems: ICD-10, CPT, HCPCS, Revenue Codes, and DRG coding for inpatient billing. - Skill in Claims Denial Management. Join us at R Systems to be part of a dynamic team that is revolutionizing technology and making a difference in the industry.
