Senior HRP Analyst - Remote Claims Testing & Validation

Goldenpick Technologies LLC; United States; A distancia; USD 110.000 - 140.000; Jornada completa

Descripción de la vacante

Goldenpick Technologies LLC is seeking a Sr. HRP Analyst for a remote position focused on healthcare claims processing and HRP workflows. You will validate EDI 837, ensure Blue Card compliance, and drive end-to-end testing across HRP-to-TPA integrations.

Strong analytic and cross-functional collaboration skills are essential. The role requires 4+ years in healthcare claims, a deep understanding of HRP, and experience with test scenario development and defect resolution.

Formación

• 4+ years of experience in healthcare claims processing, healthcare operations, or claims testing.
• Strong hands-on knowledge of local claims processing within HealthRules Payer (HRP).
• Hands-on experience working with and validating EDI 837 files.
• Experience with Blue Card claims processing and/or HRP-to-TPA workflows.
• Strong understanding of healthcare claims lifecycle, adjudication, benefits, pricing, and payment workflows.
• Good knowledge of healthcare and health-plan terminology.
• Understanding of CPT, HCPCS, ICD-9/ICD-10, CDT, Revenue, and DRG codes.
• Experience creating and executing functional, integration, and end-to-end claims test scenarios.
• Ability to analyze claims-processing results, identify defects and configuration issues, and work with technical and business teams through resolution.
• Experience working with business requirements and translating them into comprehensive test scenarios.
• Working knowledge of Azure DevOps or similar test/defect management tools.
• Strong communication skills and ability to collaborate with business and technical stakeholders.
• Experience with Association requirements and Blue Card mandates.
• Experience with benefits and package pricing configuration in HealthRules.
• SQL knowledge for data validation and claims analysis.
• Experience troubleshooting production issues related to claims or benefit configurations.
• Previous experience supporting healthcare system migrations, integrations, or major HRP enhancements.
• Experience working with Third-Party Administrator (TPA) integrations and workflows.

Conocimientos

Healthcare Claims Processing

Health Rules Payer (HRP)

EDI 837

Blue Card

Healthcare Domain Knowledge

Claims Testing

Herramientas

Azure DevOps

SQL

Descripción del empleo

Goldenpick Technologies LLC is seeking a Sr. HRP Analyst for a remote position focused on healthcare claims processing and HRP workflows. You will validate EDI 837, ensure Blue Card compliance, and drive end-to-end testing across HRP-to-TPA integrations.

Strong analytic and cross-functional collaboration skills are essential. The role requires 4+ years in healthcare claims, a deep understanding of HRP, and experience with test scenario development and defect resolution.