Business Rules Support Analyst

Inovalon•Bowie, MD

10d•$56,000 - $75,000

About The Position

Inovalon was founded in 1998 on the belief that technology, and data specifically, would empower the transformation of the entire healthcare ecosystem for the better, improving both outcomes and economics. At Inovalon, we believe that when our customers are successful in their missions, healthcare improves. Therefore, we focus on empowering them with data-driven solutions. And the momentum is building. Together, as ONE Inovalon, we are a united force delivering solutions that address healthcare’s greatest needs. Through our mission-based culture of inclusion and innovation, our organization brings value not just to our customers, but to the millions of patients and members they serve. Overview: The Business Rules Support Analyst will be responsible for providing in-depth analysis and creation of healthcare provider business rules that will modify and edit medical claims. This role requires in-depth knowledge of medical billing and coding of insurance claims from working in the healthcare profession as either a biller or at a software clearinghouse. The Support Analyst role is a customer facing role via email, ticketing, and occasionally in video meetings. This role requires the ability to review customer requests, ask for any clarifications from the requester and then create, test and publish custom claim edits on behalf of the client within company stated SLAs with a high level of quality. Requests can be customer initiated or medical insurance company mandates or necessary to ensure claims are paid timely. In addition, the Support Analyst will be responsible for reviewing claims that have failed to process in the system and come up with new edits to solve for outstanding changes that are needed within the system. The Support Analyst will work as part of a team to ensure that the Inovalon clearinghouse system maintains a high level of first pass claims acceptance rate through continued monitoring and proactive research to the changing needs of insurance claims processing.

Requirements

Required: Minimum 2 years’ experience with Medical Billing in a healthcare setting, doctor’s office or hospital; Preferred: Clearinghouse backend operations.
Understanding of Medicare NCDs, as well as Medicare/Medicaid MUE and CCI related billing rules
Solid understanding of Institutional and Professional claim forms, 5010 X12 files including 837, 835, 277 and 999.
Being able to communicate clearly with clients; client focused and sensitive to client needs
Experience working with a ticketing system; Preferred: Service Now
Direct experience building logic rules for medical claims processing.
Excellent problem solving and analytical skills.
The ability to multi-task effectively
Bachelor's degree or equivalent work experience required.

Nice To Haves

experience in application support, SaaS experience preferred, healthcare background preferred
Preferred: Service Now

Responsibilities

Take ownership of triaging incoming internal and external customer requests for medical claims processing changes needed.
Prioritize requests based on operational needs and escalate issues to quick resolution when needed.
Implement technical business rules for processing medical claims; including building logic statements based on specific medical insurance claims fields to modify and or change; test with medical claims and implement to live systems.
Take a collaborative role with the application support team to triage production problems involving claims processing, perform defect analysis and provide fixes in business logic to be implemented by software teams in a timely fashion, particularly with high priority items.
Work collaboratively with other Inovalon departments to ensure fit for purpose solutions are delivered.
Liaise with Technology and Engineering teams to resolve application issues and enhancement requests to internal tools used by the team to expand capabilities.
Ensure compliance to Company procedures when making changes and implementing new business rules.
Ensure ongoing regularly scheduled updates required for compliance are executed timely.
Responsible for accessing payer websites and compliance standards research (i.e. UB Editor, payer Companion Guides)
Review claim level and file level failures or errors ongoing to find and implement new rules as needed to ensure our first pass claim acceptance rate hits our internal goals.
Update documentation, SOPs, and training documentation as needed.
Maintain a follow up schedule for unresolved issues.
Respond to support requests through phone calls, and emails.
Assist operations with process improvement and finding solutions to business problems.
Maintain compliance with Inovalon’s policies, procedures and mission statement.
Adhere to all confidentiality and HIPAA requirements as outlined within Inovalon’s Operating Policies and Procedures in all ways and at all times with respect to any aspect of the data handled or services rendered in the undertaking of the position
Fulfill those responsibilities and/or duties that may be reasonably provided by Inovalon for the purpose of achieving operational and financial success of the Company.
Uphold responsibilities relative to the separation of duties for applicable processes and procedures within your job function.