Analyst, Strategic Operations

This is a fully remote position, open to applicants in United States.

📋 Description

• Prepare, validate, and submit Independent Dispute Resolution claims in accordance with federal and state regulations.

• Verify dispute eligibility and tailor supporting documentation for each case.

• Assess claim, payer, and determination data for precision and thoroughness.

• Address any discrepancies prior to submission.

• Manage payer escalations and enhance cash collections on previous disputes through phone, written correspondence, and fax follow-ups.

• Monitor payment status until resolution is achieved.

• Create standard operating procedures, training materials, and workflow documentation for escalation and collection processes.

• Assist in vendor management by organizing documentation, coordinating contract and information requests, tracking deliverables, and overseeing vendor performance.

• Develop and maintain reporting and metrics for the IDR program.

• Identify trends in eligibility, determinations, payer behavior, and recovery efforts.

• Translate analytical findings for non-technical audiences, executive leadership, and external stakeholders.

• Stay informed about payer guidelines, state and federal regulations, and industry standards.

• Collaborate with payers during disputes to achieve mutually beneficial outcomes and enhance payer relationships.

• Resolve data integrity and integration challenges across departments.

• Identify opportunities for process, documentation, and tool enhancements, and take ownership of assigned improvement initiatives.

• Perform additional duties as required.

• Report to the Vice President of Strategic Operations (IDR).

⛳️ Requirements

• Bachelor’s Degree in Healthcare Administration, Business, Finance, Economics, or a related field is preferred.

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

• Previous experience with various systems and platforms.

• Experience in a rapidly growing healthcare company is preferred.

• Familiarity with the Independent Dispute Resolution process under the NSA is preferred; training will be provided.

• Demonstrated critical thinking and problem-solving abilities, including navigating ambiguous or undefined challenges and suggesting a course of action.

• Proficiency in Excel, including pivot tables and VLOOKUP, and comfort with large datasets.

• Capability to work independently, prioritize competing tasks, and follow through on long-term projects with minimal supervision.

• Strong attention to detail and excellent organizational skills.

• Effective written and verbal communication skills with internal teams and external payer representatives.

• Negotiation and conflict-resolution abilities to advocate for claim approvals.

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

• Strong time management skills for managing high-volume workloads.

• Capability to work effectively under deadlines and self-manage multiple projects concurrently.

• Experience with Salesforce is preferred; familiarity with Tableau or similar visualization tools is a plus.

• Proficiency in Microsoft Office Suite or similar software.

• Understanding of healthcare compliance standards such as HIPAA and the ability to maintain confidentiality.

• Interest in learning about a complex and rapidly changing regulatory environment.

• Ability to thrive in a high-growth, fast-paced organization and fully remote work setting.

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

🏝️ Benefits

• Health Insurance (Medical, Dental, Vision).

• Life insurance.

• 401(k).

• Flexible vacation and wellness days.

• Culture of ownership, transparency, and results.

• Occasional travel for meetings and collaboration.