Business Consultant

HealthEdge • Remote,

134d • $90,000 - $120,000 • Remote

About The Position

The Business Consultant leads and mentors the Service Delivery team in Tier 1 (Basic) and Tier 2 (Intermediate) consulting initiatives. The role provides comprehensive expertise in Burgess products, payment methodologies and policies, payment integrity, and healthcare plan operations for implementation and consulting engagements, user adoption initiatives, and ongoing client support.

The position delivers product education, advises clients on healthcare payment and plan operations, collaborates with clients to define needs and solutions, and manages education services. It also handles Tier 1 and Tier 2 escalations, serves as an escalation point for critical client needs, diagnoses complex problems, coordinates with internal teams to resolve issues, and communicates with clients throughout resolution. The consultant documents client feedback and impacts, participates in root cause analysis, and helps improve services.

The role also leverages and develops capabilities and tools, mentors and oversees Tier 1 and Tier 2 Service Delivery staff, and collaborates with Service Delivery Leadership to review and enhance team performance and strategy. This is a full-time, permanent, exempt position that is remote in the US. The work may involve multiple time zones, long periods at a computer, occasional movement around an office, and travel depending on company needs.

Requirements

• Bachelor’s degree in business, health services administration, mathematics, science, or a related field, and/or equivalent work experience.
• Practical understanding of the healthcare system, including Medicare, Medicaid, managed care, commercial payment methodologies, payment integrity, and health plan operations.
• Experience interpreting or translating complex health-plan in-network and out-of-network provider rate and/or claim-editing provisions.
• Experience configuring and maintaining provider rate and/or claim-editing provisions in a claims adjudication system and/or third-party vendor application.
• Working knowledge of claim billing specifications, such as CMS-1500, UB-04, 837, and HIPAA code sets.
• Creative problem-solving skills, including identifying, recommending, and implementing strategic solutions.
• Ability to manage issues, requests, problems, and situations at all Tier 1 and Tier 2 escalation levels.
• Demonstrated ability to conduct education or training sessions for large audiences across multiple skill levels.
• Strong analytical skills.
• Excellent organizational skills.
• Excellent written and verbal communication and interpersonal skills.
• Ability to learn and adapt to new technologies and systems.
• Ability to adapt to a changing and rapidly growing environment.
• Ability to manage multiple priorities effectively and follow projects through to completion.

Nice To Haves

• AHIP, HFMA, AAPC, and/or AHIMA certification.
• Five or more years of training, education, and/or consulting experience.

Responsibilities

• Lead and mentor the Service Delivery team in Tier 1 and Tier 2 consulting initiatives.
• Provide product education on Burgess products, from basic through advanced features and functionality.
• Provide subject matter expertise on Medicare, Medicaid, and commercial payment methodologies and policies; payment integrity; and healthcare plan operations.
• Conduct collaborative scoping sessions to identify client needs and appropriate solutions.
• Manage or participate in the development, maintenance, and delivery of client-facing education services.
• Manage Tier 1 and Tier 2 escalations and serve as an escalation point for critical client needs when warranted.
• Lead diagnosis and resolution of escalated and complex client problems and issues.
• Liaise between clients and internal research, development, and product support staff to ensure accurate interpretation and resolution of problems.
• Capture and solicit issues and feedback from clients and internal stakeholders, and document issues and client impacts.
• Partner with internal teams to frame, diagnose, and resolve problems.
• Conduct or participate in root cause analysis and identify and deliver warranted service improvements.
• Maintain calm, professional, appropriately assertive conduct during pressure situations and communicate with customers throughout problem resolution.
• Leverage capabilities and tools, including knowledge libraries, workflows, and issue identification, documentation, and functional processes.
• Lead capability and tool development under the direction of Service Delivery Leadership.
• Mentor and provide oversight for Tier 1 and Tier 2 Service Delivery staff.
• Take direction from and collaborate with Service Delivery Leadership to review and enhance performance and strategy.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level