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General Position Description:
The Payer Knowledge Senior Associate is responsible for improving and aiding real-world healthcare and workflow problems. In addition, they should be helping to lead and guide individuals on the team as a more senior member of the group. You will be part of an exciting team that supports key company objectives of reducing the complexities of healthcare business. You will serve as an internal resource for investigation, communication, and management of complex payer and industry changes and their impact on the healthcare billing workflow. To succeed you will need to be a strong analytical problem solver, research and proactively look for payer changes, have excellent attention to detail and be able to work with a vast amount of information in a fast paced setting, be a critical leader who sets an example for the rest of the team and inspire them. You should be able to strive in both independent and team environments and comfortable communicating between the business and development teams. You will act as a trusted advisor to both internal and external clients.
Ability to lead by example and show leadership in information management, interpersonal skills, accountability, teaching, learning and team work.
You should have experience leading a team project.
Ability to ensure best team outcome and quality work by helping to lead the QA standards
Ability to create and help implement new processes to improve the overall team success in areas such as content and payer research, project management and execution, and case management.
Ability to proactively research, gather, analyze the payer changes in US Healthcare market and disseminate the information to the relevant stakeholders.
Ability to provide innovative ideas and solutions to the ever changing complex Healthcare Billing/Revenue processes. With the strong analytical thinking, critically evaluate the gathered information and provide insights in a timely fashion to help realize the payer changes that would impact our business. This would involve a comprehensive scoping through execution of projects and the ability to align the changing project demand with the sense of ownership and accountability.
You will be involved in comprehensive scoping, project management and execution related to Payer/Healthcare Changes. As a Payer Knowledge Senior Associate you will have ownership and accountability of these ongoing projects, and should demonstrate the ability to re-align priorities and changing project demands. You will also have responsibility to provide oversight for the team.
Ability to be a strong liaison between Business Units, Technology Teams and other stakeholders. You should become a resource in this specialized knowledge pool (Rules Engine) and work well in a team atmosphere.
Essential Duties and Responsibilities:
(Responsibilities may include, but are not limited to)
Provide leadership and guidance to Associates and Analysts in their day-to-day work, helping with prioritization, issue resolution, communication, and time management
Critically evaluate payer/healthcare information gathered from multiple sources (i.e. Payers websites, payer bulletins, social media updates, government announcements, CRM cases, other internal teams), summarize content, decompose high-level information into details, abstract up from low-level information to a general understanding, and complete user requests and/or action items as appropriate.
Proactively identify, research, understand, and resolve payer issues that impact athena and client business success.
Help to implement claims rules and other performance improvement measures based on denial and payer research
Become a go-to resource for in-depth understanding of the healthcare claim process, focusing on payer information
Conduct payer outreach and research activities and maintain active payer relationships
Prioritize, process, and resolve complex payer and client issues surrounding rules interactions to optimize client and organizational performance
Drive substantial research and/or analysis projects including paper format requirements and help with scoping of ANSI requirements
Oversee and help manage the QA processes for Payer Research, Case Management, Project Management, and any internal or external communication (such as newsletters)
Become athenahealths internal resource for investigation, communication, and management of complex payer and industry changes and their impact on the healthcare billing workflow
Serve as liaison to internal/external stakeholders on payer and vendor related projects and implementations;
Ensure that athenahealth remains at the forefront of industry and payer changes that impact the claim cycle and our clients ability to submit the cleanest claims in healthcare;
Develop innovative solutions to complex billing problems and provide recommendations with regard to new initiatives;
Establish and maintain relationships with payers, clearinghouses and other healthcare organizations;
Become an active participant in athenas teaching and learning culture
Enforce commitment to athenahealth's Corporate Compliance Code; escalate compliance issues
Skills and Abilities Required:
Ability to identify problems and see them through to resolution.
Ability to create and improve existing processes and solutions and provide alternative options
Excellent communication and organizational skills, analytical ability, and strong attention to detail.
Proven ability to work both independently on projects and as part of the larger team.
Proven ability to assume sole and independent responsibility for multiple projects from identification through to resolution.
Flexibility and willingness to take on new tasks and challenges.
Capacity to plan, prioritize, and shift focus rapidly.
Ability to instruct others, especially peers and clients to explain billing and process workflow concepts using clear communication.
Ability to create and provide both formal and informal training in areas such as Payer Research, Project Management, and the Health Care industry;
Ability to maintain poise and a sense of humor in stressful situations;
Professional attitude comfortable working in a corporate setting populated by diverse types of people
Strong computer literacy and/or the comfort, ability and desire to advance technically;
Mastery of all Microsoft Office applications, analytical tools and effective use of web/internet tools
Social Media Skills (i.e. twitter, Facebook, etc.)
Education and Experience Required:
athenahealth, Inc. sponsors and supports your professional coder certification as needed.
BA and BS degree.
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