Application Coordinator

Skills Required

• Experience in business analysis and project management.
• Knowledge of healthcare and health insurance regulatory standards.
• Epic implementation experience specifically at a health plan.
• Understanding relationships of providers and their processes in the healthcare continuum (primary care, specialists, lab ordering, surgery).
• Familiarity with case management workflows and wellness programs.
• Familiarity with or background in quality reporting initiatives such as PQRS, ACOs/MSSP, and MU.
• Familiarity with health plan concepts and workflows.
• Understanding of operations within the AP Claims department, including claim intake, review, and payment.
• Familiarity with integration points with other areas of business, such as eligibility, authorizations, and internal claims.
• Familiarity with the benefit structures of plans.
• Familiarity with the use of care plans to coordinate care for members/patients.
• Familiarity with managed care contracting.
• Understanding of treatment authorization policies/processes that affect approvals or denials and the concepts of treatment referrals and the processes followed.

Experience Required

• A minimum of 1 year of application support/build/configuration and/or related business/operational experience in a health plan or health care setting.

Education Required

This classification requires the possession of a bachelor’s degree in an IT-related or Engineering field.