Analyst, Strategic Operations

JobtailorWorkFromHome

Stellenbeschreibung:

Prepare, validate, and submit Independent Dispute Resolution disputes under federal and state requirements

Confirm dispute eligibility and customize supporting evidence for each dispute

Review claim, payer, and determination data for accuracy and completeness

Resolve discrepancies before submission

Facilitate payer escalations and drive cash collections on prior disputes through phone, written, and faxed follow-up

Track payment status through resolution

Develop standard operating procedures, training materials, and workflow documentation for escalation and collection activity

Support vendor management by organizing documentation, coordinating contract and information requests, tracking deliverables, and monitoring vendor performance

Develop and maintain reporting and metrics for the IDR program

Surface trends in eligibility, determinations, payer behavior, and recovery

Translate analytical results for non-technical audiences, executive management, and external partners

Maintain knowledge of payer guidelines, state/federal regulations, and industry standards

Collaborate with payers during disputes to reach mutually beneficial resolutions and improve payer relations

Resolve data integrity and integration issues across departments

Identify process, documentation, and tooling improvements and own assigned improvement projects

Perform other duties as assigned

Report to the Vice President of Strategic Operations (IDR)

Requirements

Bachelor’s Degree in Healthcare Administration, Business, Finance, Economics or similar is preferred

0-2 years of work experience; internship, co-op, or coursework in healthcare, finance, analytics, or operations preferred

Prior experience working with multiple systems and platforms

Experience in a high-growth healthcare company preferred

Experience with the Independent Dispute Resolution process under the NSA preferred; training will be provided

Proven critical thinking and problem-solving skills, including working through ambiguous or undefined problems and recommending a course of action

Excel proficiency, including pivot tables and VLOOKUP, and comfort working with large datasets

Ability to work independently, manage competing priorities, and follow through on long-running items with limited direct supervision

High attention to detail and excellent organizational skills

Effective written and verbal communication with internal teams and external payer parties

Negotiation and conflict-resolution skills to advocate for claim approvals

Ability to interpret and apply payer policies, state/federal regulations, and compliance standards

Proficiency in time management for high-volume workloads

Ability to work effectively under deadlines and self-manage multiple projects simultaneously

Experience with Salesforce preferred; exposure to Tableau or similar visualization tools a plus

Proficiency with Microsoft Office Suite or related software

Familiarity with healthcare compliance standards such as HIPAA and ability to maintain confidentiality

Interest in learning a complex and rapidly evolving regulatory area

Ability to thrive in a high-growth, fast-paced organization and 100% remote-based environment

Must be able to remain in a stationary position 50% of the time

Core Competencies

Demonstrates expertise in Independent Dispute Resolution processes, payer guidelines, and healthcare compliance standards while effectively managing multiple projects and priorities in a fast-paced environment. Proficient in data analysis, reporting, and communication to facilitate dispute resolutions and improve payer relations.