Homeoffice Enterprise Operations Solutions Analyst at AMERINC

Role Overview:

The Enterprise Operations Solutions Analyst is a subject matter expert and analyst on all research and analysis of provider claim issues and escalated complaints that are referred by state agencies, plans, providers, or other departments. 

 Work Arrangement:

• Remote - Associate can work remotely anywhere in the United States.
• Some travel may be needed for business meetings.

 Responsibilities:

• Responsible for supporting business processes and practices for all Lines of Business
• May need to support critical efforts outside of normal business hours, dependent on department need
• Function as a key subject matter expert for all research and analysis of provider claim payment issues
• Identify and present root causes and recommended corrections for complex operational claim payment problems that may result in policy changes, provider education, and system configuration changes.
• Develop and maintain tracking mechanisms to identify and address provider claim issues and escalated complaints through remediation.
• Analyze trends related to claim experience to identify potential issues before they arise proactively.
• Inform and influence the claims process for new initiatives or services.
• To effectively provide technical expertise, the employee must maintain a current working knowledge of processing rules, contractual guidelines, plan policy, and operational procedures.
• Develop business models and documentation to support business decisions, workflows, and processes.
• Focus on technology and business issues and communicate appropriately with technology and business experts.
• Utilize various technology applications to track, trend, and store information related to claims processing, provider maintenance, and member eligibility. 
• Build business cases that will enable business and technology change based on requirements.
• Act as a liaison and participate in defining, conveying, and documenting business requirements to solve complex claims issues, business issues, or problems.
• Provide documentation for requirements, meetings, changes, interfaces, reports, and overall workflow.

 Education & Experience:

• Bachelor’s Degree or equivalent experience.
• 2 to 3 years of healthcare experience with claims, encounters, and/or research and analysis.
• Billing and coding experience is a plus
• Extensive claims payment knowledge with critical thinking skills.
• Strong with Microsoft Office Suite (Excel, Access, Word), and SQL

 Skills & Abilities:

• Ability to establish and maintain effective relationships with all levels of the organization.
• Strong ability to multitask and address various lines of business regarding the status of efforts and business responsibilities.

• Ability to communicate effectively with all levels of associates up through executive management