Availity delivers revenue cycle and related business solutions for health care professionals who want to build healthy, thriving organizations. Availity has the powerful tools, actionable insights and expansive network reach that medical businesses need to get an edge in an industry constantly redefined by change.

GENERAL DESCRIPTION

 

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. 

 

KEY RESPONSIBILITIES

 

Research
•  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
 
Problem Solving
•  Uses best practices to conduct root cause on issues reported
•  Recommends best practices to clients and other internal stakeholders to address problem areas
 
Testing
•  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
 
CUSTOMER SCOPE
 
• Interacts with clients on a regular basis, in conjunction with the Support team
 
 

Availity is an equal opportunity employer and makes decisions in employment matters without regard to race, religious creed, color, age, sex, sexual orientation, gender identity, gender expression, genetic information, national origin, religion, marital status, medical condition, disability, military service, pregnancy, childbirth and related medical conditions, or any other classification protected by federal, state, and local laws and ordinances.

NOTICE: Federal law requires all employers to verify the identity and employment eligibility of all persons hired to work in the United States. When required by state law or federal regulation, Availity uses I-9, Employment Eligibility Verification in conjunction with E-Verify to determine employment eligibility. Learn more about E-Verify at http://www.dhs.gov/e-verify.