Kirby Bates Associates, a premier national healthcare leadership firm, is seeking a n Interim SME/Consultant, Claims Processing Configuration to support a large, organization in Missouri.
This senior-level consultant will provide hands-on configuration oversight, root-cause analysis leadership, and executive advisory support, ensuring the accuracy, integrity, and compliance of medical claims processing across FEHB and PSHB lines of business.
Requirements
- 10+ years of health plan claims operations and configuration with deep, hands-on experience configuring claims-adjudication systems and benefit set up.
- Expert-level COB and Medicare coordination knowledge-MSP rules, Part A/B coordination, secondary-payer logic.
- Hands-on experience across institutional and professional claim types, bill types/revenue codes, preventive-services adjudication, maternity/newborn benefits, and authorization/visit-limit logic.
- Experience operating across a payer-TPA relationship and holding a vendor accountable to performance and configuration standards.
- Ability to produce executive-and regulator-defensible documentation and to communicate precisely in writing.
- Must be able to be on site every other week.
Our leaders receive an attractive compensation package including housing, transportation, and regular travel home.
Kirby Bates Associates is an EEO/AA Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sexual orientation, gender, gender identity and expression, national origin, age, disability or protected veteran status. We celebrate diversity and are committed to creating an inclusive environment for all of our associates.