Application Specialist – Healthcare Insurance Systems (Billing)

Responsibilities: 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 financial systems, with a focus on Cerner workflows. Collaborate with Finance and Insurance teams to document business requirements 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 system functionality and compliance. Provide end-user training and support, including the development of training materials for system functionalities related to insurance workflows. Assist in data migration tasks, including preparing data migration templates and data collection worksheets to ensure seamless system transitions. Perform Master Data Mapping for insurance-related workflows, ensuring data consistency across systems. Participate in system upgrades, patches, and testing cycles to ensure optimal system performance. Prepare functional documentation, including SOW, workflows, and best practice. Provide on-site and remote support during go-live and post-go-live phases to ensure operational stability. Willingness to work in shifts to support critical project and operational needs Requirements Qualification: Bachelor's degree in Information Technology, Healthcare Informatics, Business Administration or a related field. 6+ years of experience in healthcare IT, particularly in RCM, Billing, and Insurance systems. Expert understanding of claims management processes, including eligibility verification, pre-authorizations, and remittances. Hands-on experience with EMR/EHR platforms (e.g., Cerner, Epic, Oracle Health or equivalent EMR) and their insurance workflows. Proficiency in Microsoft Visio for process documentation and workflow design. Skills: Strong understanding of billing and insurance workflows, including Fee for Service, DRG (Diagnosis-Related Groups), and insurance agreements. Ability to troubleshoot technical system issues and support end-users in resolving functional problems. Strong analytical and documentation skills for tracking system performance and reporting issues. Understanding of HL7 messaging formats and ability to validate insurance-related transactions. Flexibility to work in shifts to provide necessary system support.