Hi, I have an urgent requirement with one of my clients. Please find the job details below and forward me your updated resume along with your contact details at *skum...@tekshapers.com <mgu...@tekshapers.com>* or call me at *248-565-4747 <248-565-4747>*168*
*Business Analyst (Medicare exp.)* Minnetonka, MN 12+ Months F2F interview is required *Required:* *Experience with setup of a system or administered Medicare benefits and claims. * *Understand and be able to speak to NCD/LCD’s * 1. For example, what is the criteria contained in the NCD/LCD? 2. Help us determine what additional logic goes into the claims payment system vs the CES editing system to manage LCD/NCD? Does logic need to be configured in both places? *Understand Medicare benefits (Prime/Cost, Select Solution and hopefully Advantage plans) * 1. What is covered? 2. What is not covered? (Is this handled by the NCD/LCD? ) 3. How cost sharing is applied to the benefit if applicable? *Are there different rules for institutional vs. professional, units billed, different place of service, global fee’s vs. non?* 1. For example, what does this mean and how is it different than other claims being billed etc –“Spinal Designs/Low Back Rehab providers bill a one-time global fee for multiple PT visits; visits are indicated by the number of units billed. A member copay applies per visit. Any deductible and/or coinsurance apply as usual” 2. How to administer the benefits (What things do we actually operationalize in the claims system vs. what things are language in the CMS contract and are not operationalized) 3. What is handled generally in provider contracts vs benefits 4. COB *Rules with Medicare based on product and individual services * 1. Cost sharing rules 2. Medicare Compliance 3. How limits should be administered 4. Help us determine why things are being manually processed today and how to proceed forward based on CMS rules? Options? Compliance? 5. How are other companies handling a specific Medicare benefit? 6. Medicare Best Practices on Benefits/Claims operations Regards *Sumit Kumar* Sr. Talent Acquisition *T: 248.565.4747 | Extn. 168* *skum...@tekshapers.com <skum...@tekshapers.com>* Fax : +1-248.254.7211 Tekshapers Inc. 1441 E. Maple Rd, Suite # 301,Troy, MI, 48083 Certification: WMBE Certified | E-Verified Company | ISO 9001:2008 *Email is the best way to reach me.* Save trees. Print Only When Necessary *Disclaimer: If you are not the intended recipient, please contact the sender by reply e-mail and destroy all copies of the original message. If you are not interested in receiving our e-mails then please reply with a "REMOVE" in the subject line at **rem...@tekshapers.com* <rem...@tekshapers.com>* and mention all the e-mail addresses to be removed with any e-mail addresses, which might be diverting the e-mails to you. We are sorry for the inconvenience.* -- You received this message because you are subscribed to the Google Groups "SAP-UK" group. To unsubscribe from this group and stop receiving emails from it, send an email to sap-uk+unsubscr...@googlegroups.com. To post to this group, send email to sap-uk@googlegroups.com. Visit this group at https://groups.google.com/group/sap-uk. For more options, visit https://groups.google.com/d/optout.
