HealthEdge Benefits Overview

Design, develop, test, and maintain enterprise-scale healthcare software using C#, .NET, RESTful APIs, SQL Server, and modern JavaScript frameworks. Build scalable features, optimize databases, address concurrency issues, debug complex systems, contribute to architecture decisions, and support the full software development lifecycle. Collaborate with distributed cross-functional teams while helping modernize infrastructure through AWS migration, microservices, and cloud technologies.

Conduct prospective, concurrent, and retrospective utilization reviews for inpatient, outpatient, ambulatory, and ancillary services. Assess medical necessity, length of stay, care levels, appeals, benefits, eligibility, and coordination of care. Collaborate with medical personnel on treatment alternatives, transfers, discharge planning, and care plans. Research regulatory requirements, resolve authorization issues, coordinate services, and educate providers on policies and benefits.

Leads business and functional requirements for healthcare payer core administration implementations covering claims, enrollment, provider, authorization, and payment systems. Partners with customers, vendors, product, architecture, development, QA, and offshore teams to translate healthcare processes into technical requirements, workflows, user stories, and EDI mappings. Supports Agile ceremonies, solution design, risk management, stakeholder walkthroughs, MVP demonstrations, and go-live decisions.