[Remote] Business Consultant
Note: The job is a remote job and is open to candidates in USA. HealthEdge is a company focused on healthcare solutions, and they are seeking a Business Consultant to lead and mentor the Service Delivery team. The role involves providing subject matter expertise, managing client education services, and resolving complex client issues.
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