RCM Business Enablement Analyst
New
J
JobgetherHealthcare Revenue Cycle
US, Aligned with Central TimeFull-TimeMiddle
Salary not disclosed
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Job Details
- Experience
- 5+ years of healthcare industry experience required; 1–3 years of relevant professional experience preferred.
- Required Skills
- Project ManagementData AnalysisCRM
Requirements
- 5+ years of healthcare industry experience required.
- 1–3 years of relevant professional experience preferred.
- Background in healthcare revenue cycle management, billing, or coding strongly preferred.
- Working knowledge of managed care contracting and reimbursement modeling.
- Understanding of CMS reimbursement guidelines, including Medicare, IPPS, and OPPS logic.
- Strong analytical thinking for evaluating data, workflows, and systems.
- Strong verbal and written communication skills.
- Demonstrated project management capabilities.
- Familiarity with CRM systems, learning management platforms, and data analytics tools.
- Strong collaboration skills with clients and cross-functional teams.
- High attention to detail and accuracy.
- Customer-centric mindset.
Responsibilities
- Build, test, maintain, and optimize insurance payer contracts and expected reimbursement rules.
- Apply healthcare, technical, analytical, and financial knowledge to ensure payer contracts are accurately implemented.
- Coordinate with Operations to validate and maintain reimbursement rules.
- Maintain reimbursement model updates including Medicare outpatient quarterly updates and annual DRG changes.
- Perform comprehensive QA and testing on reports, outputs, and model results before production.
- Partner with clients and leadership to resolve managed care contract and reimbursement-related issues.
- Support Revenue Acceleration onboarding by developing workflows, providing training, and performing QA.
- Analyze processes, systems, and data to identify gaps and recommend solutions.
- Conduct ad hoc analyses and contribute to continuous improvement documentation.
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