Note: The job is a remote job and is open to candidates in USA. Ovation Healthcare supports independent community hospitals and health systems through consulting guidance, operational expertise, and technology-enabled shared services. The RCM Business Enablement Analyst implements and maintains payer contracts and expected reimbursement rules, performs quality assurance and analysis, and supports Revenue Acceleration projects through data validation, process development, training, and implementation. The role also coordinates with operations, clients, managers, and team leads to ensure accurate and effective healthcare revenue cycle processes.
Responsibilities
- Building, testing, and maintaining insurance payor contracts
- Building, testing, and maintaining expected reimbursement rules to accurately calculate expected reimbursement
- Use of in-depth healthcare knowledge, technical, analytical, and financial skills to ensure all aspects of a contract are implemented and managed throughout the life of the payor contract
- Coordinate with the company’s operations department to ensure that expected reimbursement rules are up-to-date and accurate after initial build, QA, and testing
- Maintain all updates for expected reimbursement rules, such as Medicare OP quarterly updates, yearly Diagnostic Related Grouper (DRG) updates, and yearly increases for the Managed Care contracts
- QA and testing models by reviewing multiple reports and output prior to publishing live models
- Coordinate managed care contract questions with Clients, Managers, and Team Leads as applicable
- Assist with onboarding Revenue Acceleration projects including identifying and validating data requirements, creating workflows and processes, training, and QA during the implementation process
- Performance of ad hoc analyses as assigned by departmental Director, Manager, or Team Lead
Skills
- Knowledge of administrative and clerical procedures and systems such as word processing, managing files and records, designing forms, writing policies, and other office procedures and terminology
- Knowledge of business and management principles involved in strategic planning, resource allocation, production methods, and coordination of people and resources
- Analytical Thinking: Ability to analyze data, processes, and systems to identify gaps, understand needs, and propose effective solutions
- Communication Skills: Strong verbal and written communication skills to convey complex information clearly and to facilitate training sessions and presentations
- Project Management: Proficiency in managing projects from conception through to implementation and review, including time management and task prioritization
- Technical Proficiency: Familiarity with a range of tools and technologies used in enablement, including Client Relationship Management systems, Learning Management Systems platforms, data analytics tools, and content management systems
- Collaboration: Ability to work effectively with cross-functional teams and build strong relationships with clients and Operations leaders
- Problem-Solving: Strong problem-solving skills to quickly identify issues and develop effective solutions
- Adaptability: Flexibility to adapt to changing needs, new technologies, and evolving business processes
- Attention to Detail: Detail-oriented approach to ensure accuracy and completeness in enablement activities and documentation
- Customer-Centric Mindset: Understanding of end-user needs and the ability to design enablement solutions that enhance user experience and productivity
- 5+ years in a healthcare background is required
- Knowledge of CMS guidelines includes Medicare, IPPS, and OPPS reimbursement logic
- This position is remote and requires long periods of sitting, interfacing with a desktop computer or laptop including mouse and keyboard, using a hard phone or soft phone
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- Minimum of 1-3 years of experience preferred
- Working knowledge of managed care contracting and modeling desired
- Preferred to have knowledge in billing and coding
Benefits
- Remote work arrangement
- Training sessions and presentations
- Onboarding support and training during the implementation process
Company Overview