Jobs at Tegria

Analyzes, implements, supports, and optimizes healthcare EDI transactions in a payer environment. Responsibilities include HIPAA X12 transaction monitoring, troubleshooting, mapping, testing, implementation, documentation, regulatory compliance, trading partner onboarding, root cause analysis, and production support. The role collaborates with business stakeholders, providers, clearinghouses, vendors, and technical teams while supporting payer platforms and healthcare claims, enrollment, eligibility, and payment processes.

Translate business requirements into operational and technical solutions, evaluate Epic workflow enhancements, resolve process issues, guide stakeholders toward best practices, and train less experienced IT staff. The role requires expertise in Epic application workflows, strong analytical and communication skills, project management ability, healthcare business acumen, and current Epic Healthy Planet and Compass Rose Clinical Build certification.

Performs financial and revenue integrity audits, reconciliations, trend analysis, root cause investigations, and corrective actions to ensure billing accuracy and prevent revenue leakage. Develops dashboards and KPI reporting, supports financial analysis, and configures PSA project budgets, billing, milestones, and revenue allocations. Partners with Accounting, Sales, Service Delivery, Talent, and IT to resolve issues, maintain system accuracy, and improve Finance Operations processes.

The Director of Payer manages client engagements, operational management, business development, and people management while overseeing P&L, driving profitability, and ensuring team success.

Configure, test, implement, and maintain the TriZetto Facets core claims processing system. Translate business requirements into system configurations for benefits, claims, provider, products, pricing, and eligibility. Support UAT, production support, upgrades, integrations, impact analysis, testing, documentation, and regulatory compliance while partnering with business, operations, and IT teams.

Configure, maintain, and support provider reimbursement and pricing within TriZetto Facets and NetworX. Translate provider contracts into system configurations, build and test reimbursement models, run SQL queries and reports, troubleshoot claims/pricing issues, perform testing and validations, document configurations, and collaborate with contracting, claims, data, and IT teams for upgrades and process improvements.