About this role
Essential Job Duties
- Gather, analyze, validate, and document customer, payer, business, and technical requirements, and translate payer specifications and companion guides into scalable configurations and integration solutions.
- Independently own assigned payer integration and configuration work from requirements definition through testing, validation, and production readiness.
- Configure and maintain payer-specific billing rules, claim submission logic, enrollment requirements, reimbursement workflows, and related system integrations.
- Analyze and troubleshoot implementation and production issues; identify root causes; evaluate alternatives; and recommend and implement appropriate corrective actions within the role's scope.
- Partner with Implementation, Product, Engineering, Operations, payer, and client-facing teams, and support Senior Solution Analysts on complex requirements, escalations, and broader implementation efforts.
- Execute testing, validation, and quality assurance activities to confirm configurations and integrations meet documented requirements and expected outcomes.
- Support payer onboarding, production-readiness activities, enhancement requests, and ongoing optimization of payer configurations and integrations.
- Monitor and maintain payer configurations and integrations to support performance, accuracy, and compliance with payer requirements.
- Create and maintain requirements, configuration decisions, test results, operating procedures, internal tools, training materials, and best-practice documentation, and provide knowledge transfer.
- Serve as a resource who bridges technical, operational, payer, and customer requirements while meeting service-level agreements, delivery standards, and internal procedures.
Other Job Duties
- Other duties as assigned by supervisor or HHAeXchange leader.
Travel Requirements
- Travel up to 10%, including overnight travel
Required Education, Experience, Certifications and Skills
- Four or more years of relevant experience in healthcare revenue cycle, payer operations, claims processing, healthcare technology, healthcare data integration, or healthcare software implementation.
- Working knowledge of Medicaid and managed care organization revenue cycle and payer processes, including claim submission, payer responses, reimbursement, rejections, and denials.
- Working knowledge of healthcare electronic data interchange and X12 standards, including 837, 835, 270/271, and 276/277 transactions.
- Experience interpreting payer specifications, companion guides, implementation requirements, and data elements; documenting business and technical requirements; and translating them into configuration or integration requirements.
- Experience working with configuration-driven software platforms and managing multiple implementation or configuration activities through completion.
- Strong analytical and troubleshooting skills, including the ability to identify root causes, evaluate alternatives, and determine appropriate next steps.
- Knowledge of common healthcare integration methods and technologies, including secure file transfer protocol and application programming interfaces.
- Strong written and verbal communication, organization, attention to detail, and the ability to ask effective discovery questions, challenge assumptions constructively, make recommendations, prioritize work, and collaborate across functions.
- Experience with work-management and documentation tools such as Jira, Salesforce, Confluence, or SharePoint, and the ability to independently own assigned responsibilities within a cross-functional delivery model.
- Ability to work on-site three days per week in the New York, Miami, or Bloomington office, with in-office requirements subject to change based on business needs.
- Preferred experience includes home care or home care technology, healthcare software as a service, Health Level Seven or Fast Healthcare Interoperability Resources standards, or work with state Medicaid agencies, home care providers, or clearinghouses.
- Willingness to explore and adopt AI tools responsibly to enhance productivity and innovation in your role.