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