RCM Business Enablement Analyst

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

📋 Description

• Develop, evaluate, and sustain insurance payor contracts.

• Construct, assess, and uphold expected reimbursement rules to accurately determine anticipated payments.

• Utilize healthcare, technical, analytical, and financial expertise to manage contracts throughout the payor contract lifecycle.

• Collaborate with Operations to ensure that expected reimbursement rules remain up-to-date and precise following the initial setup, quality assurance, and testing.

• Keep current with updates for expected reimbursement rules, including quarterly Medicare OP updates, annual DRG updates, and yearly Managed Care contract increases.

• Conduct quality assurance and test models by analyzing reports and outputs prior to the release of live models.

• Address managed care contract inquiries from clients, managers, and team leads.

• Support the onboarding of Revenue Acceleration projects, which includes validating data requirements, establishing workflows and processes, providing training, and performing implementation quality assurance.

• Execute ad hoc analyses as directed by the departmental Director, Manager, or Team Lead.

⛳️ Requirements

• A minimum of 1–3 years of relevant experience is preferred.

• At least 5 years of experience in a healthcare setting is required.

• Familiarity with managed care contracting and modeling is desirable.

• Preferred knowledge includes billing and coding practices.

• Understanding of CMS guidelines, including Medicare, IPPS, and OPPS reimbursement logic.

• Awareness of administrative and clerical procedures and systems, such as word processing, file and record management, form design, policy writing, and office terminology.

• Comprehension of business and management principles related to strategic planning, resource allocation, production methods, and coordination of personnel and resources.

• Capability to analyze data, processes, and systems to pinpoint gaps, recognize needs, and suggest solutions.

• Excellent verbal and written communication skills.

• Expertise in project management from initial conception through implementation and evaluation.

• Familiarity with CRM systems, LMS platforms, data analytics tools, and content management systems.

• Ability to work collaboratively with cross-functional teams, clients, and Operations leadership.

• Strong problem-solving abilities.

• Adaptability to evolving needs, technologies, and business processes.

• Detail-oriented mindset in enablement activities and documentation.

• Awareness of end-user needs and the capability to design enablement solutions that enhance user experience and productivity.

• Ability to work for extended periods using a desktop computer or laptop, mouse and keyboard, and hard or soft phone.

🏝️ Benefits

• Remote work arrangement.

• 0% travel requirement.