Business Consultant

HealthEdge • Remote, OR

388d • Remote

About The Position

The Business Consultant leads and mentors the Service Delivery team in Tier 1 and Tier 2 consulting initiatives, providing comprehensive subject matter expertise in Source products, payment methodologies, and healthcare plan operations. This role focuses on implementation, strategic user adoption, and ongoing client support, aiming to enhance payment integrity and operational efficiency for health plans.

Requirements

• Bachelor's degree in business, health services administration, mathematics, science or related field, and/or equivalent work experience required.
• 5+ years training, education, and/or consulting experience preferred.
• Practical understanding of the healthcare system regarding Medicare, Medicaid, managed care, and commercial payment methodologies.
• Experience with interpretation/translation of complex health-plan provider rate and claim editing provisions.
• Working knowledge of claim billing specifications (e.g., CMS-1500, UB-04, 837, HIPAA code sets).
• Strong analytical skills and excellent organizational skills.
• Excellent communication (both written and verbal) and interpersonal skills.

Nice To Haves

• AHIP, HFMA, AAPC, and/or AHIMA certification preferred.
• Creative problem-solving skills including the ability to identify, recommend, and implement strategic solutions.
• Demonstrated ability to conduct education/training sessions to large audiences across multiple skill levels.

Responsibilities

• Provide the highest level of product education to Source end-users.
• Conduct collaborative scoping sessions to identify client needs and appropriate solutions.
• Manage issues and inquiries of Tier 1 and 2 escalation.
• Lead diagnosis and resolution of escalated client problems and issues.
• Act as a liaison between clients and internal support staff to assure accurate problem interpretation and resolution.
• Capture and solicit issues/feedback from clients and internal stakeholders.
• Partner with Source Teams to manage problem framing, diagnosis, and resolution.
• Conduct root cause analysis to identify and deliver service improvements.
• Maintain communication with customers during the problem resolution process.
• Mentor and provide oversight for Tier 1 and 2 Service Delivery staff.

Benefits

• Full-time, permanent employment
• Remote work flexibility
• Diversity and inclusion initiatives
• Professional development opportunities

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Bachelor's degree