Note: The job is a remote job and is open to candidates in USA. HealthEdge is a company focused on providing comprehensive solutions in the healthcare sector. The Business Consultant leads the Service Delivery team in consulting initiatives, offering expertise in healthcare payment methodologies and operations while managing client support and education services.
Responsibilities
- Provide the highest level of product education (from basic to advanced features/functionality to Burgess end-users
- Provide in-depth and comprehensive subject matter expertise related to:
- Medicare, Medicaid, and commercial payment methodologies/policies
- Payment integrity
- Healthcare plan operations (e.g., claim adjudication life cycle/workflows, network contracting, payment/policy related configuration, provider relations, medical management, medical economics, audit, compliance)
- Conduct collaborative scoping sessions to identify client needs and appropriate solutions
- Actively manage and/or participate in the development, maintenance, and execution of client facing education services
- Manage issues, questions, inquiries of Tier 1 and 2 escalation
- Serve as escalation point for critical client needs as warranted
- Lead diagnosis and resolution of escalated and more involved/complex client problems and issues
- Act as a liaison between clients and internal support staff (research, development, and product teams) to assure accurate problem interpretation and resolution
- Capture and solicit issues/feedback from clients and internal stakeholders and document issues and client impacts
- Partner with appropriate Burgess Teams (BA, PM, Development, Account Management, Sales/Business Development, Product, Content, and Service Delivery) to manage problem framing, diagnosis and resolution
- Conduct/participate in root cause analysis to identify and deliver warranted service improvements
- Maintain demeanor as a calming influence during pressure situations, mixing in the correct degree of professional assertiveness without becoming aggressive
- Maintain communication with customers during the problem resolution process, utilizing superior customer service skills
- Leverage capabilities and tools (knowledge libraries, workflow, issue identification and documentation, function processes)
- Lead capability and tool development under direction of Service Delivery Leadership
- Mentor and provide oversight for Tier 1 and 2 Service Delivery staff
- Take direction from and collaborate with Service Delivery Leadership to continually review and enhance performance and strategy
Skills
- Bachelor's degree in a business, health services administration, mathematics, science or related field, and/or equivalent work experience required
- Practical understanding of the healthcare system with regards to Medicare, Medicaid, managed care, and commercial payment methodologies, payment integrity, and health plan operations (e.g., claim life cycle/workflows, network contracting, payment/policy related configuration, provider relations, medical management, medical economics, audit, compliance)
- Experience with interpretation/translation of complex health-plan in-network and out-of-network provider rate and/or claim editing provisions
- Experience with configuration and maintenance of provider rate and/or claim editing provisions in a claims adjudication system and/or third-party vendor application
- Working knowledge of claim billing specifications (e.g., CMS-1500, UB-04, 837, HIPAA code sets)
- Creative problem-solving skills including the ability to identify, recommend, and implement strategic solutions
- Ability to manage issues, requests, problems, and situations of all Tier 1 and 2 escalation levels
- Demonstrated ability to conduct education/training sessions to large audiences across multiple skill levels
- Strong analytical skills
- Excellent organizational skills
- Excellent communication (both written and verbal) and interpersonal skills
- Ability to learn and adapt to new technologies and systems
- Ability to adapt to a changing and rapidly growing environment
- Effectively manage multiple priorities and follow through on all projects to completion
- AHIP, HFMA, AAPC, and/or AHIMA certification preferred
- 5+ years training, education, and/or consulting experience preferred
Company Overview
Company H1B Sponsorship