Analyst

ü SubjectMatter Expert in NASCO Claims Processing System and other claims systems likeFacets.

o Expert in NASCO systems - HIQK, HEHK, HURK, HSSK, TPOL(GENO table), BlueSquared and eFDE applications.

o In-depth knowledge of HIPAA 4010 and 5010 transactions and834, 835, 837I 837P, 270, 271, 276, 277 claims and ICD 9 / 10 Diagnostic Codesets to support the analysis of current business processes across multiple BluePlans.

o Solid working experience on Provider Vouchers, Explanationof Benefits, outbound 835 forms using NASCO systems and Facets system.

o Very good experience in FlexLink/Non-enrolled (Third Party Administration)claims end to end processing including outbound 837 validations and loadingresponses to queried claims via Inbound 835 format using NPS.

o Vast experience with ITS (Home/Host, BlueCard) claimsprocessing across BCBS Plans

ü Expertknowledge of BCBS way of working in Provider, Professional, Facility, COB,Medicare Claims processing using NASCO products such as NPS, PMR, MembersEdge,BeneFACT, AccumConnect and Navigator.

ü Functionalexperience in HealthCare industry Benefits, Membership, Eligibility, Claimsand Billing with strong exposure to HIPAA Healthcare Standards and HIPAAImplementation Guide (IG)

ü Leadexperience in managing the BCBS stakeholders and executing complex projectsthat run across multiple BCBS plans (BCBSMI, NJ, MN and MA)