Business Consultant

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

📋 Description

• The Business Consultant is responsible for leading and mentoring the Service Delivery team in all Tier 1 (Basic) and Tier 2 (Intermediate) consulting activities.

• This role offers extensive subject matter expertise regarding Burgess products (covering both basic and advanced features/functionality), payment methodologies/policies (including Medicare, Medicaid, and commercial), payment integrity, and healthcare plan operations (such as claim life cycle/workflow, network contracting, payment/policy configuration, provider relations, medical management, medical economics, audit, compliance) related to implementation/consulting engagements, strategic user adoption initiatives, and ongoing client support.

• Deliver advanced levels of product education (ranging from basic to advanced features/functionality) to Burgess end-users.

• Provide in-depth and comprehensive subject matter expertise pertaining to: Medicare, Medicaid, and commercial payment methodologies/policies.

• Ensure payment integrity.

• Oversee healthcare plan operations (including claim adjudication life cycle/workflows, network contracting, payment/policy related configuration, provider relations, medical management, medical economics, audit, compliance).

• Facilitate collaborative scoping sessions to determine client needs and suitable solutions.

• Actively manage and/or contribute to the development, maintenance, and execution of client-facing educational services.

• Address issues, questions, and inquiries pertaining to Tier 1 and 2 escalations.

• Serve as the escalation point for critical client needs as necessary.

• Lead the diagnosis and resolution of escalated and more complex client problems and issues.

• Act as a liaison between clients and internal support staff (including research, development, and product teams) to ensure accurate problem interpretation and resolution.

• Gather and document issues and feedback from clients and internal stakeholders, noting client impacts.

• Collaborate with relevant Burgess teams (BA, PM, Development, Account Management, Sales/Business Development, Product, Content, and Service Delivery) to manage problem framing, diagnosis, and resolution.

• Conduct or participate in root cause analysis to identify and deliver necessary service improvements.

• Maintain communication with customers throughout the problem resolution process, employing exceptional customer service skills.

• Mentor and provide oversight for Tier 1 and 2 Service Delivery staff.

• Follow guidance from and collaborate with Service Delivery Leadership to continually assess and enhance performance and strategy.

⛳️ Requirements

• A bachelor’s degree in business, health services administration, mathematics, science, or a related field, along with equivalent work experience is required.

• AHIP, HFMA, AAPC, and/or AHIMA certification is preferred.

• A minimum of 5 years of experience in training, education, and/or consulting is preferred.

• A practical understanding of the healthcare system regarding Medicare, Medicaid, managed care, and commercial payment methodologies, payment integrity, and health plan operations (such as claim life cycle/workflows, network contracting, payment/policy related configuration, provider relations, medical management, medical economics, audit, compliance) is essential.

• Experience interpreting/ translating complex health-plan in-network and out-of-network provider rate and/or claim editing provisions is required.

• Familiarity with the configuration and maintenance of provider rate and/or claim editing provisions within a claims adjudication system and/or third-party vendor application is necessary.

• A working knowledge of claim billing specifications (e.g., CMS-1500, UB-04, 837, HIPAA code sets) is expected.

• Strong creative problem-solving abilities, including the capacity to identify, recommend, and implement strategic solutions.

• Proficient in managing issues, requests, problems, and situations at all Tier 1 and 2 escalation levels.

• Proven ability to conduct education/training sessions for large audiences across various skill levels.

• Strong analytical capabilities.

• Excellent organizational skills.

• Outstanding communication (both written and verbal) and interpersonal skills.

• Ability to learn and adapt to new technologies and systems.

• Flexibility to adapt to a fast-paced and evolving environment.

• Capable of effectively managing multiple priorities and ensuring the completion of all projects.

🏝️ Benefits

• Health insurance.

• 401(k) matching.

• Flexible work hours.

• Paid time off.

• Remote work options.