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Company

HealthEdge · 22 hours ago

Business Consultant

United States

Full-time

Remote

Senior Level

5+ years exp

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Enterprise SoftwareHealth Care

H1B Sponsor Likely

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Responsibilities

Provide the highest level of product education (from basic to advanced features/functionality to Source 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 Source 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.

Qualification

Find out how your skills align with this job's requirements. If anything seems off, you can easily click on the tags to select or unselect skills to reflect your actual expertise.

Medicare payment methodologiesMedicaid payment methodologiesPayment integrityHealthcare plan operationsClaims adjudicationProvider relationsMedical managementMedical economicsAudit complianceConfiguration of claimsAHIP certificationHFMA certificationAAPC certificationAHIMA certificationTraining experienceEducation experienceConsulting experience

Required

Bachelor’s degree in a business, health services administration, mathematics, science or related field, and/or equivalent work experience

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

Preferred

AHIP, HFMA, AAPC, and/or AHIMA certification

5+ years training, education, and/or consulting experience

Company

HealthEdge

Glassdoor

3.6

HealthEdge Software offers benefits administration and care management software solutions.

Founded in 2004

Burlington, Massachusetts, USA

1001-5000 employees

http://www.healthedge.com

H1B Sponsorship

HealthEdge has a track record of offering H1B sponsorships. Please note that this does not guarantee sponsorship for this specific role. Below presents additional info for your reference. (Data Powered by US Department of Labor)

Distribution of Different Job Fields Receiving Sponsorship

Represents job field similar to this job

Trends of Total Sponsorships

2023 (32)

2022 (47)

2021 (44)

2020 (27)