Rate Operations Analyst / 1854 Job in Waltham 02451, Massachusetts Us
Rate Operations Analyst / 1854
Position Description:
JOB SUMMARY: This position is responsible for analyzing, researching and consulting on both standard and complex practitioner and ancillary reimbursement.
JOB ROLES AND RESPONSIBILITIES:
1. Perform standard reimbursement/data analyses of low to moderate complexity which will support Network Development contract negotiations for selected provider and contract types. This includes providing consultation on best practices for fee schedule design that will result in the highest level of repricing efficiency and accuracy.
2. Collaborate with Network Development to analyze and report on the impact of practitioner negotiations to the Company’s bottom line.
3. Coordinate fee schedule approval process for assigned fee schedule types. Re-establish deadlines as needed based on priorities and communicate change to customer.
4. Implement all approved fee schedules in the approved systems and cross check implemented fees downstream to ensure accuracy.
5. Perform industry and systems research to troubleshoot and resolve contractual rate issues in support of Network Development, Service Operations and other departments, as requested.
6. Assess customer training needs and provide continuous education as needed to internal and external customers. Communicate training needs to department management.
7. Perform all pre-implementation contract rate review/analysis and provide first-level approval on standard rate exhibits. Work and consult with Network Development and management to develop complex or non standard language options that will ensure optimal accuracy in repricing.
8. Collaborate with internal and external Quality Analysis/Internal Audit teams to research, troubleshoot and resolve discrepancies found in any and all work flows and fee schedules audited. Provide feedback to optimize quality and improve auditing processes.
9. Participate in internal and cross-functional projects that require a moderate level of business analysis skills.
10. Perform analyses of moderate to high complexity relative to fee schedule and network discount performance, including but not limited to: adjustment for market default (banded) fee schedules.
11. Lead/perform routine or special analyses or projects of moderate to high complexity for complex fee schedules, including but not limited to Leased Network and Settlement fee schedules.
12. Serve as back up to the Senior Operations Analyst in performance of repricing testing and analyses to ensure accuracy of fee schedules and to test rate process changes and system enhancements to coincide with projects lead internally or externally by the ITPMA division.
13. Participate in the development and maintenance of all internal applications and tools used by the practitioner rate operations team for fee schedule development.
14. Collaborate, coordinate, and communicate across disciplines and departments.
15. Ensure compliance with HIPAA regulations and requirements.
16. Demonstrate commitment to the Company’s core values.
17. The position responsibilities outlined above are in no way to be construed as all encompassing. Other duties, responsibilities, and qualifications may be required and/or assigned as necessary.
JOB SCOPE:
The incumbent works under general supervision within established standard and guidelines (“parameters”) for quality and efficiency. The incumbent exercises independent decision making, discretion, and choice within parameters on moderate to highly complex issues concerning applicability as well as to prioritize and balance their workload to ensure efficient and timely work output. One has the authority to determine an appropriate course of action in absence of defined parameters. While the incumbent works closely with others serving as resources and mentors, one can choose appropriate course of action to handle and resolve issues. The incumbent works collaboratively with other departments and has regular interaction with colleagues internal and external to the department. Work output is regularly reviewed for accuracy and the work of the incumbent impacts revenues and claims repricing activities. The most complex issues are referred to the Team Lead.
Qualifications:
JOB REQUIREMENTS (Education, Experience, and Training):
• Bachelor’s degree in a related field such as business or healthcare administration, or 3 years experience in an analytical role
• Minimum 2 years experience in an analytical role within the health care industry, with an emphasis on financial or reimbursement analytics
• At least one year experience in the Practitioner Rate Analyst role with the Company is preferred.
• Experience participating in the design, testing, implementation and training of applications
• Knowledge of spreadsheets and databases
• Knowledge of operational/technical review of health care contracts
• Knowledge of the Company’s practitioner reimbursement (contracts and fee schedules) is preferred.
• Knowledge of health care claims, billing and reimbursement concepts
• Required licensures, professional certifications, and/or Board certifications as applicable
• Communication (written, verbal, listening), team work, attention to detail, leadership, problem solving, research, troubleshooting, and organization skills
• Ability to efficiently and effectively manage large, complex data sets and devise meaningful information and reports from data sets.
• Ability to work cohesively with parties at all levels of the organization
• Ability to effectively prioritize and manage multiple priorities
• Ability to manage routine types of work with a focus on quality optimization
• Ability to use software, hardware, and peripherals related to job responsibilities, including MS Office Suites, database software, and advanced reporting techniques
As an Equal Opportunity Employer, the Company will provide equal consideration to all employees and job candidates without regard to sex, age, race, marital status, sexual orientation, religion, national origin, citizenship status, physical or mental disability, political affiliation, service in the Armed Forces of the United States, or any other characteristic protected by federal, state, or local law.