Sr. Healthcare Business Application Expert – ClaimsXTen Consultant

posted on April 23, 2018

Job Description

Location: Durham, NC

Duration: 3+ Months, Contract to Hire

Description:

  • CXT is a complex application that requires deep knowledge of claims, claim processing, claim pricing, and the operational functions of prior authorization, clinical coding and management, and pricing and reimbursement in order to ensure rule content and logic meets multiple business needs (clinical editing, administrative editing, and provider transparency).
  • {Provider transparency is afforded through the sister application to CXT, Clear Claim Connection (C3).}
  • Define CXT rule logic in cross-functional sessions with McKesson/Change Healthcare, Medical Policy, and Network Management.
  • Support testing by TriZetto SIT and Topaz QE; coordination and test case support across both testing teams.
  • Write test cases and maintain CXT-specific test case workbooks.
  • Manage routine updates to the CXT application (data dictionary, TPIC, code sets) that require promotion through multiple lower regions in the TriZetto hosted environment.
  • Create and track service request tickets for each change and each set of regions (one for DEV and TEST and one for PPMO and PROD).
  • Coordination with TriZetto Hosting and the Topaz Service Desk.
  • Manage all of the above for any internally generated changes such as Medical Policy code or policy changes.
  • Stay current with operational configuration not only of CXT but of Facets and NetworX pricing.
  • The combination of CXT rule logic and Facets with NetworX pricing require strong knowledge of not only CXT but of claim processing in Facets and NetworX pricing functionality.
  • Faults in CXT rule logic can cause problems with Facets and/or pricing, and vice versa.
  • Troubleshoot issues with CXT (also dependent on a strong understanding of how these applications work together).
  • Respond to inquiries from operational areas who have questions about CXT editing.
  • Work with McKesson and TriZetto at least annually to review rule firing order and logic to ensure optimal configuration.
  • Ensure rule justifications and edit clarifications display correctly in C3 and in Facets.
  • Analyze claim data and CXT reports to further refine CXT rule logic, content or provide feedback to Medical Policy.
  • Support Special Investigations Unit by identify CXT configuration that can support any on-going investigations.
  • Understanding of and ability to work closely with the Medical Policy team for interpretation and understanding of medical and reimbursement policies for translation into configuration of ClaimsXTen and ClaimCheck.
  • Ability to independently research common sourcing entities such as CMS, AMA, and other medical governing bodies for guidance/instruction on correct claim coding.
  • Ability to analyze claim data to understand if rule logic is being applied correctly or if revisions to the logic and/or content are required.
  • CPC-P Coding certification preferred.
  • Ability to use tools like Encoder Pro to understand correct coding

 

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