Job Summary ( Role Purpose)

The Application Specialist – Billing & Insurance will be a techno-functional role within the HICT department, primarily responsible for supporting the configuration, maintenance, and troubleshooting of Health Insurance, Billing and Revenue Cycle Management (RCM) systems at PHCC. The role will focus on ensuring smooth insurance workflows within IT systems, assisting internal teams, and ensuring compliance with healthcare insurance regulations.

The individual will work closely with internal IT teams, business stakeholders, and end-users to ensure system performance, troubleshoot technical issues, and support process improvements. This role requires strong technical skills, a foundational understanding of health insurance processes, and experience in working with RCM and billing systems, particularly within Cerner EMR and other integrated healthcare platforms. The Application Specialist will report to the Health Insurance Project Manager.

Key Accountabilities & Duties:

• Assist in the configuration, maintenance, and troubleshooting of RCM, Billing,and Insurance systems to ensure compliance with operational requirements.
• Support billing rules setup, corporate accounts, exemptions, markups, and pre-authorization workflows as per health insurance standards.
• Provide support for claims lifecycle processes, including eligibility checks, pre-authorizations, billing, coding, claim submissions, and remittance processing.
• Support the integration of insurance data with internal EMR and financial systems, with a focus on Cerner workflows.
• Collaborate with Finance and Insurance teams to document business requirements and assist in translating them into system workflows.
• Prepare and execute test cases for System Testing, User Acceptance Testing(UAT), Unit Testing (UT), and Functional Testing (FT), focusing on system functionality and compliance.
• Provide end-user training and support, including the development of training materials for system functionalities related to insurance workflows.
• Assist in data migration tasks, including preparing data migration templates and data collection worksheets to ensure seamless system transitions.
• Perform Master Data Mapping for insurance-related workflows, ensuring data consistency across systems.
• Prepare functional documentation, including SOW, workflows, and best practices.
• Provide on-site and remote support during go-live and post-go-live phases to ensure operational stability.
• Willingness to work in shifts to support critical project and operational needs

Education Requirements:

Bachelor’s degree in Computer Science, Business or Health Care

Certification, license or training Requirements:

Expert understanding of claims management processes, including eligibility verification, pre-authorizations, and remittances. Hands-on experience with EMR/EHR platforms (e.g., Cerner, Epic, Oracle Healthor equivalent EMR) and their insurance workflows

Experience & Knowledge:

6+ years of experience in healthcare IT, particularly in RCM, Billing, and Insurance systems.