What are the responsibilities and job description for the NASCO claims Specialist position at X2 logics?
• Serve as primary SME for end to end NASCO claims processing across professional, institutional, and pharmacy claims.
• Provide strategic direction and domain leadership for claims testing initiatives.
• Interpret and guide implementation of complex payer rules, benefit configurations, and provider contracts.
• Review and validate regulatory compliance with CMS, HIPAA, Medicare, Medicaid, and commercial plan requirements.
• Proactively identify domain risks, gaps, and improvement opportunities in claims workflows.
Testing Strategy & Governance
• Define overall NASCO claims testing strategy, scope, and coverage for releases.
• Review and approve test plans, scenarios, and test data from a domain correctness perspective.
• Ensure comprehensive validation of:
o Claims adjudication logic
o Pricing and repricing
o Accumulators (deductibles, MOOP)
o COB and subrogation
o Authorizations, edits, and exceptions
• Lead UAT planning and execution, including business readiness and sign off.
• Own defect triage decisions, prioritization, and root cause analysis.