[Remote] CCA Consultant with Healthcare Payer systems

Note: The job is a remote job and is open to candidates in USA. Kodeva LLC is seeking a CCA Consultant with expertise in healthcare payer systems. The role involves analyzing business requirements, configuring healthcare payer applications, and ensuring compliance with healthcare regulations while collaborating with cross-functional teams.

Responsibilities

• Analyze business requirements and translate them into system configuration solutions
• Configure healthcare payer applications based on business and regulatory requirements
• Design and maintain benefit plans, provider contracts, pricing, claims, eligibility, and authorization configurations
• Perform impact analysis for new enhancements, system upgrades, and production changes
• Troubleshoot configuration-related issues and provide root cause analysis
• Collaborate with Business Analysts, Developers, QA teams, and business stakeholders throughout the Software Development Life Cycle (SDLC)
• Prepare configuration documentation, technical specifications, and process documents
• Support User Acceptance Testing (UAT), System Integration Testing (SIT), and production validation
• Ensure compliance with healthcare regulations including HIPAA, CMS, and state-specific requirements
• Participate in release planning, deployment, and post-production support
• Mentor junior configuration analysts and provide subject matter expertise
• Support audits, regulatory compliance activities, and production issue resolution
• Resolve configuration defects within SLA
• Perform production impact analysis
• Support incident, problem, and change management activities
• Coordinate production deployments
• Conduct post-implementation validation
• Document lessons learned and best practices

Skills

• Bachelor's degree in Computer Science, Information Systems, Healthcare Administration, or a related field
• 7–12+ years of experience in healthcare payer systems
• 5+ years of hands-on configuration experience
• Experience working with cross-functional teams
• Strong analytical and problem-solving skills
• Excellent communication and stakeholder management skills
• Healthcare payer domain expertise
• Claims processing lifecycle
• Benefits configuration
• Provider contract configuration
• Pricing and reimbursement methodologies
• Member eligibility configuration
• Authorization and referrals
• Enrollment processes
• Medicare and Medicaid knowledge
• Commercial health insurance products
• Experience with healthcare platforms such as Facets, QNXT, HealthRules, or similar payer systems
• Configuration management
• SQL for data validation and troubleshooting
• XML and EDI transactions (837, 835, 834, 270/271)
• SDLC and Agile methodologies
• Jira, Azure DevOps, or similar project management tools
• Microsoft Excel and reporting tools
• Experience with Facets CCA configuration
• Knowledge of HIPAA transactions
• Experience with Medicare Advantage and Medicaid products
• Agile or Scrum certification is a plus
• Healthcare industry certifications are preferred
• Facets CCA
• SQL Server
• Oracle Database
• Healthcare Claims Processing
• Benefit Configuration
• Provider Configuration
• Pricing Configuration
• EDI Transactions
• HIPAA
• Medicare and Medicaid
• Agile Scrum
• Azure DevOps
• Jira
• ServiceNow

Company Overview

Kodeva is one of the fast emerging leaders in providing affordable and cutting-edge IT and Engineering services for organizations fortune 100 - Fortune 500. It was founded in 2019, and is headquartered in Ashburn, Virginia, USA, with a workforce of 51-200 employees. Its website is https://www.kodeva.com.

Company H1B Sponsorship

Kodeva LLC has a track record of offering H1B sponsorships, with 5 in 2026, 7 in 2025, 5 in 2024, 4 in 2023, 9 in 2022, 5 in 2021, 5 in 2020. Please note that this does not guarantee sponsorship for this specific role.