Project Manager (Claims and Pre-Authorization)

Derex Technologies Inc specializes in providing IT consulting, staffing solutions and software services. Globally headquartered in Harrison New Jersey since 1996 Derex delivers the highest quality technology professionals and an array of customized IT talent solutions designed to improve productivity and drive results to global clients throughout North America.

With over two decades of unparalleled experience, Derex provides supports to its clientele, across such industries as Systems Integration, Banking and Finance, Telecommunications, Pharmaceutical and Life Sciences, Energy, Healthcare, Technology, Transportation, and local and federal Government agencies.

Position: Project Manager (Claims and Pre-Authorization)

Location: Parsippany-Troy Hills, NJ, USA(On-Site)

Job Description

Overview:

As a Healthcare Project Manager specializing in claims processing and pre-authorization, you will play a critical role in optimizing the development of our products. Your expertise will contribute to efficient claims management, accurate pre-authorization decisions, and streamlined processes.

Responsibilities:

• Analyze end-to-end claims workflows, from submission to payment.
• Collaborate with stakeholders (insurers, providers, patients) to identify process improvements.
• Understand how to Ensure compliance with industry standards (e.g., HIPAA)
• Evaluate pre-authorization requests for medical services or procedures.
• Verify medical necessity and adherence to guidelines.
• Facilitate timely approvals by working closely with providers and payers.
• Utilize tools like Excel, SQL, and data visualization platforms.
• Create reports, dashboards, and presentations to communicate insights.
• Monitor performance metrics related to claims and pre-authorization.
• Collaborate with IT teams to enhance products and development of claims processing systems.
• Gather requirements for system upgrades and new features.
• Maintain strong communication with cross-functional business units.

Regards,

Manoj

Derex Technologies INC

Contact : 973-834-5005 Ext 206

All your information will be kept confidential according to EEO guidelines.