Application Specialist - Billing & Insurance

Job Summary ( Role Purpose)

Key Accountabilities & Duties

• Assist in the configuration, maintenance, and troubleshooting of RCM, Billing,and Insurance systems to ensure compliance operational requirements.
• Support billing rules setup, corporate accounts, exemptions, markups, and pre-authorization workflows as per health insurance standards.
• Provide support for claims lifecycle processes, including eligibility checks, pre-authorizations, billing, coding, claim submissions, and remittance processing.
• Support the integration of insurance data with internal EMR and financialsystems, with a focus on Cerner workflows.
• Collaborate with Finance and Insurance teams to document businessrequirements and assist in translating them into system workflows.
• Prepare and execute test cases for System Testing, User Acceptance Testing(UAT), Unit Testing (UT), and Functional Testing (FT), focusing on systemfunctionality and compliance.
• Provide end-user training and support, including the development of trainingmaterials for system functionalities related to insurance workflows.
• Assist in data migration tasks, including preparing data migration templates anddata collection worksheets to ensure seamless system transitions.
• Perform Master Data Mapping for insurance-related workflows, ensuring dataconsistency across systems.
• Prepare functional documentation, including SOW, workflows, and best practice.
• Provide on-site and remote support during go-live and post-go-live phases toensure operational stability.
• Willingness to work in shifts to support critical project and operational needs

Education Requirements

Experience & Knowledge