V2Soft is a global leader in IT services and business solutions, delivering innovative and cost-effective technology solutions worldwide since 1998. We have We have headquartered in Bloomfield Hills, MI and have 16 offices spread across six countries. We partner with Fortune 500 companies to address complex business challenges. Our services span AI, IT staffing, cloud computing, engineering, mobility, testing, and more. Certified with CMMI Level 3 and ISO standards, V2Soft is committed to quality and security. Beyond our work, we actively support local communities and non-profits, reflecting our core values. Join us to be part of a dynamic and impactful global company!
Please visit us at www.V2soft.com to know more.Functional knowledge:
Utilization management and prior authorization — authorization lifecycle, medical necessity review, inpatient and outpatient requests, determinations, appeals and turnaround obligations.
Care and disease management — case creation and stratification, care plans, assessments, member outreach, vendor referral.
Benefit configuration — how program and product benefits map to purchasing groups, including base and buy-up tiers.
Membership and eligibility — Commercial, Federal Employee Program and Medicare Advantage, and how coverage periods drive case and authorization behavior.
Quality and regulatory — HEDIS, NCQA accreditation and Star ratings, and how application data supports them. CMS interoperability awareness an advantage.
Correspondence — member and provider letter generation and the regulatory timing attached to it.
Platform experience:
Highly desirable — Cognizant CareAdvance (care and utilization management) and CareAdvance Provider / E-Referral (provider prior authorization portal) in a payer environment.
Also relevant — TriZetto CareAdvance, Facets, QNXT, HealthEdge GuidingCare, ZeOmega Jiva, Altruista, or an equivalent in-house UM/CM system.
Transactions and interfaces — EDI X12 278 authorization request and response; 834, 837 and 835 useful. FHIR and clearinghouse integration such as Availity an advantage.
Technical skills:
SQL — confident writing queries against Oracle and SQL Server to validate requirements, trace a record and confirm a defect. A working requirement, not a nice-to-have.
Data structures — able to read a data model and follow a field from source file through staging to the consuming application.
Tooling — JIRA, Confluence or SharePoint, TOAD or SQL Developer. ETL concepts (Informatica or similar) and batch scheduling exposure useful.
Testing — test case design, UAT coordination and defect triage. Postman or SOAP UI for web service validation an advantage.
Certifications: IIBA CBAP or ECBA; PMI-PBA; CSPO. AHIP or AHM 250 payer certification desirable
V2Soft is an Equal Opportunity Employer ( EOE). We welcome applicants from all backgrounds, including individuals with disabilities and veterans. https://www.v2soft.com/careers - to view all of our open opportunities and to learn more about our benefits.
Numbers & Facts
Location
Bloomfield Hill, MI
Skills
Acceptance Testingunmatched
Artificial Intelligence (AI)unmatched
Atlassian JIRAunmatched
Bug Tracking/Defect Managementunmatched
Business Solutionsunmatched
Capability Maturity Model Integration (CMMI)unmatched
Cloud Computingunmatched
Community Supportunmatched
Content Management Systems (CMS)unmatched
Data Modelingunmatched
Data Structuresunmatched
Database Extract Transform and Load (ETL)unmatched
Disease Prevention and Controlunmatched
Electronic Data Interchange (EDI)unmatched
Fortune 500 Customersunmatched
Functional Analysisunmatched
Health Planunmatched
Healthcare Effectiveness Data and Information Set (HEDIS)unmatched
ISO (International Organization for Standardization)unmatched
Informaticaunmatched
Interoperabilityunmatched
Machine Toolunmatched
Mail Servicesunmatched
Medicareunmatched
Microsoft SQL Serverunmatched
Microsoft SharePointunmatched
National Committee for Quality Assurance (NCQA)unmatched
Nonprofitunmatched
Oracle Databaseunmatched
Patient Careunmatched
Patient Care Authorizationsunmatched
Purchasing/Procurementunmatched
Quest Software TOADunmatched
Regulationsunmatched
Requirements Validation/Verificationunmatched
SOAP (Simple Object Access Protocol)unmatched
SQL (Structured Query Language)unmatched
Software Engineeringunmatched
Technical Leadershipunmatched
Technical Recruitingunmatched
Test Caseunmatched
Test Designunmatched
Testingunmatched
User Interface/Experience (UI/UX)unmatched
Utilization Managementunmatched
Web Servicesunmatched
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