Sr Enterprise Rules and Edits Consultant

Waystar • Atlanta, GA

109d

About The Position

Waystar is seeking a smart, technical and creative Enterprise Rules & Edits Analyst seeking a chance to grow their career and work with claim billing & coding/authorization rules. This analytical, solution-oriented individual will report to a Director of Enterprise Rules & Edits and work closely with client support and technology teams. This role will serve as an expert in government and payer requirements, focusing on how to help our clients improve clean claim rates and reduce denials against those constraints.

Requirements

• Bachelor’s degree or 2-4 years of equivalent experience in healthcare setting.
• Understanding and knowledge of hospital revenue cycle workflows and the provider reimbursement process from patients and payers.
• Problem solving skills; able to analyze a problem and design creative solutions.
• Planning and organization skills to independently develop and lead projects when applicable.
• Excellent written communication skills; able to succinctly convey complex ideas through writing.
• Flexible and agile; able to rapidly adapt to changing situations and inputs.

Nice To Haves

• Medical claims coding certification preferred.

Responsibilities

• Work with product, client support and technical teams to deliver accurate, timely claim edit/authorization rule configurations.
• Study healthcare industry standards and stay up-to-date on industry changes and compliance issues, focusing on government/payer requirements for claims billing & coding/authorization.
• Leverage analytical tools (Excel, PowerBI, SQL Databases) to identify trends and outliers in EDI 837/835/278 transaction data.
• Transform data into actionable claim edits, policy recommendations or authorization rule configurations.
• Configure system settings and options; plan and execute unit, integration and acceptance testing.
• Serve as a subject matter expert in medical billing and coding, authorization rules and requirements, EDI 835/837.
• Consult with high-value clients to optimize claim edit/authorization rule configurations.
• Develop sustainable processes and systems to ensure claim edits are accurately and efficiently maintained.

Benefits

• Competitive total rewards (base salary + bonus, if applicable).
• Customizable benefits package (3 medical plans with Health Saving Account company match).
• Generous paid time off for non-exempt team members, starting with 3 weeks + 13 paid holidays, including 2 personal floating holidays.
• Flexible time off for exempt team members + 13 paid holidays.
• Paid parental leave (including maternity + paternity leave).
• Education assistance opportunities and free LinkedIn Learning access.
• Free mental health and family planning programs, including adoption assistance and fertility support.
• 401(K) program with company match.
• Pet insurance.
• Employee resource groups.

What This Job Offers

• Education Level: Bachelor's degree
• Number of Employees: 51-100 employees