HRP Configuration Specialist [remote contract] Job

Position summary

The HRP Configuration Analyst is responsible for the end-to-end configuration, maintenance, and testing of benefit and claims processing rules within the Health Rules Payor (HRP) platform by HealthEdge. This role serves as the technical bridge between clinical/product operations and system configuration, ensuring accurate benefit adjudication, compliant claims payment, and high-quality testing outcomes across all lines of business.

Benefit configuration

· Configure and maintain benefit plans, cost-sharing structures, accumulators, and coverage rules in Health Rules Payor (HRP)

· Translate benefit plan documents (SBCs, EOBs, product grids) into accurate HRP system configuration

· Set up and manage benefit periods, deductibles, out-of-pocket maximums, copays, coinsurance, and exclusion/limitation logic

· Configure coordination of benefits (COB), subrogation rules, and Medicare/Medicaid crossover logic as applicable

· Support annual benefit year rollover, plan refresh, and mid-year plan amendments

Claims testing & validation

· Design and execute end-to-end claim test scripts (professional, institutional, dental, pharmacy) to validate configuration accuracy

· Perform regression, UAT, and production validation testing for new configurations and system upgrades

· Identify, document, and track defects; partner with IT and HealthEdge support for resolution

· Validate claim adjudication outcomes against expected benefit logic including repricing, edits, and remittance advice

· Maintain test case libraries and testing documentation in support of audit and compliance requirements

Cross-functional collaboration

· Partner with product, clinical operations, finance, and compliance teams to gather configuration requirements and confirm business intent

· Serve as a subject matter expert on HRP functionality during product launches, regulatory changes, and system enhancements

· Participate in HealthEdge upgrade planning, release management, and production cutover activities

· Support provider network loading, fee schedule configuration, and code table maintenance as needed

Quality, governance & documentation

· Maintain thorough configuration change documentation, version control, and audit trail records

· Develop and follow configuration standards, SOPs, and naming conventions across the HRP environment

· Support internal and external audits related to claims payment accuracy and benefit administration compliance

· Monitor post-production claim runs for configuration anomalies and escalate issues appropriately

Required qualifications

3+ years of hands-on HRP (HealthEdge Health Rules Payor) configuration experience
Strong working knowledge of medical claim adjudication logic and benefit plan structures
Experience with ICD-10, CPT, HCPCS, and revenue code sets
Proficiency in claim testing methodology (unit, regression, UAT)
Familiarity with HIPAA 837/835 transaction standards
Strong analytical skills with attention to configuration detail and accuracy
Ability to translate complex benefit documents into system configuration requirements

Preferred qualifications

Experience with HealthEdge product suite (HealthRules Payor, GuidingCare, HealthRules Intelligence)
Background in commercial, Medicare Advantage, or Medicaid managed care
SQL proficiency for data validation and ad hoc claims analysis
Exposure to Agile or hybrid project environments
HealthEdge certification or HRP administrator training completion
Bachelor's degree in health information management, business, IT, or related field

Core competencies

HRP configuration, Claims adjudication, Benefit plan design, UAT & regression testing, COB logic, HIPAA 837/835, HealthEdge platform, Defect tracking

We have enterprise solutions for interoperable and secure data exchange in healthcare, retail, logistics and travel industries. We also provide security consulting and staff augmentation services to our clients.