Job Description

Requisition ID: 40507 City: Long Beach Country/Region: US Wipro Limited (NYSE: WIT, BSE: 507685, NSE: WIPRO) is a leading technology services and consulting company focused on building innovative solutions that address clients’ most complex digital transformation needs. Leveraging our holistic portfolio of capabilities in consulting, design, engineering, and operations, we help clients realize their boldest ambitions and build future-ready, sustainable businesses. With over 230,000 employees and business partners across 65 countries, we deliver on the promise of helping our customers, colleagues, and communities thrive in an ever-changing world. For additional information, visit us at Job Description Role Purpose A Medicare domain consultant is a healthcare professional with deep expertise in Medicare regulations, policies, and procedures who advises clients, such as healthcare providers, payers, or technology companies, on optimizing their operations related to Medicare programs, including patient eligibility, billing practices, compliance, and benefit design, to maximize efficiency and revenue while adhering to Medicare guidelines. Qualifications A bachelor’s degree in health care administration, Public Health, Population Health, Finance, Business Analytics or related field and/or equivalent experience 10+ years’ experience of work in Healthcare Payer experience and systems. 10+ years of experience in healthcare analytics, strategy, and/or consulting at an IPA or health plan level, required Good understanding of Medicare, Medicaid and other government healthcare programs. Experience with Eligibility, Enrollment and Revenue Reconciliation is highly preferred. Demonstrated expertise in a variety of concepts, practices, and procedures applicable to utilization management, care management functional areas 5+ years of health plan experience, highly desired Three or more years of recent experience in risk adjustment Strong understanding of risk adjustment operations and V28 payment model and condition categories Knowledge of HIPAA regulations Knowledge of Medicare Advantage, STARS/HEDIS program, and NCQA technical specifications, a plus Knowledge and understanding of ICD-10, CPT and CPT (II), and HCPCS, a plus Project management and program management experience You will need to be competent with computers and healthcare applications. You will need to keep up to date with current healthcare literature. Present strong skills in analysis and presentation. Be able to communicate well verbally and in written form to people from different backgrounds. Excellent interpersonal skills to build relationships with clinical and non-clinical personnel Strong analytical and creative problem-solving skills Ability to analyze issues/errors reported by customer and perform first level of analysis before handing over to technical teams. Act as the single point of contact for clients, manage stakeholders and customer expectations, and facilitate resolution of issues. Basic understanding of Databases, with hands-on experience in writing queries and analyzing data files, if required to aid analysis and support activities (mandatory) Proactively manage Client needs by understanding business requirements, criticality of issues, ensuring timely updates and maintaining customer satisfaction. Experience in conducting Product demonstrations and End user training. Experience in SAFe Agile and Jira. Expected annual pay for this role ranges from $100,000 to $200,000. Based on the position, the role is also eligible for Wipro’s standard benefits including a full range of medical and dental benefits options, disability insurance, paid time off (inclusive of sick leave), other paid and unpaid leave options. Reinvent your world. We are building a modern Wipro. We are an end-to-end digital transformation partner with the boldest ambitions. To realize them, we need people inspired by reinvention. Of yourself, your career, and your skills. We want to see the constant evolution of our business and our industry. It has always been in our DNA - as the world around us changes, so do we. Join a business powered by purpose and a place that empowers you to design your own reinvention. Come to Wipro. Realize your ambitions. Applications from people with disabilities are explicitly welcome. If you encounter any suspicious mail, advertisements, or persons who offer jobs at Wipro, please email us at helpdesk.recruitment@wipro.com . Do not email your resume to this ID as it is not monitored for resumes and career applications. Any complaints or concerns regarding unethical/unfair hiring practices should be directed to our Ombuds Group at ombuds.person@wipro.com . We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, caste, creed, religion, gender, marital status, age, ethnic and national origin, gender identity, gender expression, sexual orientation, political orientation, disability status, protected veteran status, or any other characteristic protected by law. Wipro is committed to creating an accessible, supportive, and inclusive workplace. Reasonable accommodation will be provided to all applicants including persons with disabilities, throughout the recruitment and selection process. Accommodations must be communicated in advance of the application, where possible, and will be reviewed on an individual basis. Wipro provides equal opportunities to all and values diversity. #J-18808-Ljbffr Wipro Technologies

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