Job Description:

Cognizant Technology Solutions is seeking for “RTB Lead”; this resource should have strong experience Who could join in our team of IT professionals in a permanent role If you meet our background requirements and skills and looking for an opportunity to be rewarded for your skills and expertise, here is the ideal opportunity for you!

Location: Phoenix, AZ

"QNXT Configuration:

• The role will aid in configuration design, analyze, validate QNXT configuration set up not limited to Benefit/Contracts/Sponsors/Authorizations

• Loads and Maintains Reference Tables/ codegroupers/ servicegroups/ modifiers/locations etc.

• Creates and Maintains Fee Schedules and CAP rate tables.

• Perform Root Cause Analysis on Benefit/Contract Scoring and provide resolution

• Create Solution Document for all Configuration related updates into the system.

• Coordinate Build and Interact with other Analysts to determine the best approach for a config build

• Function as a Subject Matter Expert on all QNXT Benefit/Contract configuration questions.

• Ability to create and test claims pertaining to benefit/contract builds

• Improve Auto Adjudication rates by addressing core system edits/rules.

• Work with internal and external stake holders/health plans/business analysts.

• Understand QNXT data table and Schema definitions. Validate data housed on DBs, ensure adherence to business and system requirements.

• Develop standard operating procedure and guidelines, ensures service level agreements are met. Provides status reports and project updates to management and stakeholders • Understand QNXT/NetworX configuration set up Overall Experience (Preferred): 

• At least 10 Yrs Experience in the Healthcare Domain, Administering Benefit/Contracts/Providers/Claims Processing

• 5-6 Yrs Experience using the QNXT platform Version 5.1 -5.7 desired for senior roles

• Prudent problem solving and analytical skills

• Knowledge on Provider Billing/Coding procedures desired

• Knowledge on SQL Data Structures

• Effective presentation and interpersonal Skills.  Ability to handle multiple competing priorities.

• Good Knowledge on Medicaid/Medicare Lines of Business

• Clearly articulate (both verbal and written) issues and provide alternative solutions.

Technical Skills

SNo	Primary Skill	Proficiency Level *	Rqrd./Dsrd.
1	QNXT - Utilization Management	PL4	Required
2	QNXT - Providers	PL4	Required

 

* Proficiency Legends

Proficiency Level	Generic Reference
PL1	The associate has basic awareness and comprehension of the skill and is in the process of acquiring this skill through various channels.
PL2	The associate possesses working knowledge of the skill, and can actively and independently apply this skill in engagements and projects.
PL3	The associate has comprehensive, in-depth and specialized knowledge of the skill. She / he has extensively demonstrated successful application of the skill in engagements or projects.
PL4	The associate can function as a subject matter expert for this skill. The associate is capable of analyzing, evaluating and synthesizing solutions using the skill.

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