RCM Business Enablement Analyst
Accountabilities: Build, test, maintain, and optimize insurance payer contracts and expected reimbursement rules to support accurate reimbursement calculations.
Apply healthcare, technical, analytical, and financial knowledge to ensure payer contracts are accurately implemented and effectively managed throughout their lifecycle.
Coordinate with Operations to validate and maintain reimbursement rules following initial development, quality assurance, and testing.
Maintain reimbursement model updates, including Medicare outpatient quarterly updates, annual DRG changes, and yearly increases for managed care contracts.
Perform comprehensive QA and testing by reviewing reports, outputs, and model results before publishing changes to production.
Partner with clients, managers, and team leads to research and resolve managed care contract questions and reimbursement-related issues.
Support Revenue Acceleration onboarding initiatives by identifying and validating data requirements, developing workflows and processes, providing training, and performing QA throughout implementation.
Analyze processes, systems, and data to identify gaps, improve efficiency, and recommend practical solutions.
Conduct ad hoc analyses and other projects as assigned by departmental leadership.
Maintain accurate documentation and contribute to continuous improvement across business enablement processes and tools.
Requirements:
1–3 years of relevant professional experience preferred, with 5+ years of healthcare industry experience required .
Background in healthcare revenue cycle management, billing, coding, or related areas strongly preferred.
Working knowledge of managed care contracting and reimbursement modeling is desirable.
Understanding of CMS reimbursement guidelines, including Medicare, IPPS, and OPPS logic.
Strong analytical thinking and the ability to evaluate data, workflows, and systems to identify issues and develop effective solutions.
Strong verbal and written communication skills, including the ability to explain complex information and facilitate training or presentations.
Demonstrated project management capabilities, including prioritization, organization, time management, implementation, and follow-through.
Familiarity with business enablement technologies such as CRM systems, learning management platforms, data analytics tools, and content management systems.
Strong collaboration skills and the ability to build productive relationships with clients, Operations leaders, and cross-functional teams.
High attention to detail and a consistent focus on accuracy, completeness, and quality.
Customer-centric mindset with the ability to understand end-user needs and develop solutions that improve productivity and experience.
Adaptability and willingness to learn new technologies, processes, and business requirements.
Ability to work independently as a self-starter while effectively collaborating with a broader team.
Comfortable working remotely for extended periods using a desktop or laptop, phone, keyboard, and mouse.
Benefits:
Fully remote position within the United States, aligned with Central Time.
Full-time employment.
No travel required ; travel expectation is 0%.
Opportunity to work at the intersection of healthcare, revenue cycle management, technology, analytics, and business enablement.
Collaborative environment with opportunities to work alongside healthcare operations and subject-matter specialists.
Exposure to payer contracting, reimbursement modeling, Medicare methodologies, and Revenue Acceleration initiatives.
Opportunity to contribute to process improvement, operational efficiency, and technology-enabled healthcare solutions.
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