As a Business Operation Analyst, you serve as a business resource to the Edit Content Management Team. Key responsibilities includes in-depth research and review of payer specific authorization rules, review utilization trends and make adjustments accordingly, update and maintenance of existing rules, participating in initiatives to improve the quality and content of rule data and promoting positive relationships and goodwill so profitable accounts are retained and grown.
• Reviews payer websites and communications for changes to prior authorization processes
• Research and thoroughly document payer prior authorization requirements for maximum efficiency and effectiveness of Prior Authorization processes
• Triage Prior Authorization requests for urgency and priority
• Basic ability to conduct a root cause analysis of the data process to determine data anomalies
• Uses best practices to conduct root cause on issues reported
• Recommends best practices to clients and other internal stakeholders to address problem areas
• Ability to review and analyze business rules, edits and bridge routines to meet payer guidelines and ensure Availity and/or customer SLA’s are met
• Identify patterns of issues occurring within data
• Conduct comprehensive unit testing and business testing to include the positive and negative test cases
• Produce clear and concise results from testing conducted that can be shared within the organization and with clients
The above cited duties and responsibilities describe the general nature and level of work performed by people assigned to the job. They are not intended to be an exhaustive list of all the duties and responsibilities that an incumbent may be expected or asked to perform.
EDUCATION AND EXPERIENCE
• 3+ years of billing experience
• Experience submitting and researching authorization requests
• Familiar with various payer websites and payer specific guidelines related to authorizations
• High School diploma or equivalent
• A BA/BS degree is a plus
• Experience working with healthcare and/or internet applications
• Experience in Agile software development methodology environment a plus
• Institutional billing experience a plus
• Experience working with practice management software a plus
SKILLS AND KNOWLEDGE
• Very detailed oriented
• Provider Analysis – Able to interview customer and gather appropriate details to thoroughly understand their needs and their workflow.
• Communicates effectively, both inside and outside the organization, on both simple and complex topics.
• Commands attention and manages group process during the presentation.
• Writes clearly and succinctly in a variety of communication settings and styles
• Gets messages across that prompts or obtains appropriate actions
• Interacts with clients on a regular basis, in conjunction with the Support team