NASCO Claims Domain Specialist Job at Purple Drive, Newark, NJ

RmNPQkRlR3lDQ2x1V2lrSkxBL1VXSTZ6
  • Purple Drive
  • Newark, NJ

Job Description

  • 15+ years of experience in US Healthcare Insurance with strong NASCO Claims domain expertise.
  • Serve as the primary SME for end-to-end NASCO Claims Processing (Professional, Institutional, and Pharmacy claims).
  • Lead UAT planning, execution, validation, and business sign-off activities.
  • Strong knowledge of Claims Adjudication, Pricing/Repricing, Accumulators, COB, and Subrogation.
  • Review and validate test plans, test scenarios, test data, and claims workflows.
  • Expertise in EDI transactions including 837, 835, 270/271, and healthcare claims lifecycle.
  • Ensure compliance with CMS, HIPAA, Medicare, Medicaid, and Commercial Health Plan requirements.
  • Act as the key liaison between Business, Product Owners, Operations, Development, and QA teams.
  • Lead defect triage, root cause analysis, and testing governance activities.
  • Strong leadership, stakeholder management, and mentoring experience with onsite/offshore testing teams.

Job Tags

Similar Jobs

EquipmentShare

Parts Manager Job at EquipmentShare

 ...Build the Future with Us EquipmentShare is Hiring a Parts Manager At EquipmentShare, were not just filling a role were assembling the best team on the planet to build something thats never been built before . Were on a mission to transform an industry thats been... 

BAY College

Men's Assistant Basketball Coach Job at BAY College

 ...Position Details Position Information Position Title Men's Assistant Basketball Coach Pay Grade Level Assistant Coaches FLSA Exempt Benefits Contributions into the Michigan Public School Employees Retirement System... 

1308 - Dave's Hot Chicken - Crosskeys Chicken

Assistant General Manager Job at 1308 - Dave's Hot Chicken - Crosskeys Chicken

 ...Description Job Description Summary: The Assistant General Manager will support the General Manager coordinating, directing and...  ...delegation, and problem-solving skills Strong attention to detail and ability to multitask Confident, proactive, and willing to... 

Aramark

Custodial Services Worker - Northrop Grumman BWI (JLL) Job at Aramark

Job Description Are you self-motivated and proud of the work you do? Here at Aramark, we take pride in our level of service and safety we provide! Cleanliness is a necessity of every business. As a Custodial Services worker on our team, youll take on the important...

Box

Large Enterprise Account Executive Job at Box

 ...companies thrive in the new AI-first era of business. Founded in 2005, Box simplifies work for leading global organizations, including JLL, Morgan Stanley, and Nationwide. Box is headquartered in Redwood City, CA, with offices across the United States, Europe, and Asia....