Sr Enterprise Rules and Edits Consultant

Waystar • Atlanta, GA

5d

About The Position

This Senior Consultant, Enterprise Rule & Edits position reports to our Enterprise Rules & Edits Manager and has the responsibility for establishing new client payer edit configurations. The goal of the position is to ensure implementation clients exceed clean claim targets and report high satisfaction with Waystar edit processes and content. This will be achieved through active involvement in scoping, project planning, implementation, and stabilization. The Consultant will leverage billing and coding subject matter expertise and industry experience to advise clients in best practices and build a comprehensive payer edit library. The Consultant will partner with Client Operations, Client Success and Product to identify product enhancements that will improve client satisfaction and efficient use of resources. WHAT YOU'LL DO This cross-functional position will work with product, client support and technical teams to deliver accurate, timely claim edit/authorization rule configurations.

Requirements

• 10 + years of experience in a healthcare setting
• Strength discussing both complex technical information and general revenue cycle operations
• Exceptional organizational and analytical skills to manage multiple priorities and deliver timely and accurate results
• Demonstrated problem solving and decision-making process
• Proficient in research investigation
• EDI 835/ 837/270/276/ 278, X12 structures, formats, and standards
• Strong process orientation, problem solving & troubleshooting skills, and a firm commitment to quality
• HIPAA regulation knowledge
• Healthcare terminology
• Proficient with Microsoft Office Suite
• Good written and oral communication skills; team player
• Experience with EDI and/or healthcare transactions required
• Ability to travel up to 20 %
• Ability to communicate with all levels of hospital / physician business office personnel.

Nice To Haves

• Knowledge Experience with Epic, Cerner, eCW , Nextgen, Meditech and other PM/HIS systems
• Certified medical coder (CPC , RHIT, CPB, CCS, etc )
• Experience with Waystar EDI solutions

Responsibilities

• Studying healthcare industry standards and staying 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 Design new payer edits based on a new client’s payer mix and facility types
• Subject matter expert in claim edits and payer policies
• Advise onboarding clients on optimizing claim rules and edits to prevent rejections and denials while reducing pended claim volume
• Participate in project scoping and planning to design a client-specific rule and edit recommendations
• Partner with product and technology teams to prioritize and deliver new functionality to meet the rule , edit , and claims reporting needs of onboarding clients
• Clearly communicate Waystar’s rule and edit capabilities and value to clients during implementation
• Analyze previous vendor rule and edit configurations for parity , configure new rules and edits to fill any gaps
• Analyze parallel testing results to identify differences in expected to actual results, design new system logic to address any gaps
• Study trends in custom rule and report requests to prioritize for product enhancements
• Serve as liaison to Pr oduct to implement needed enhancements
• Other duties as assigned

Benefits

• Competitive total rewards (base salary + bonus, if applicable)
• Customizable benefits package (3 medical plans with Health Saving Account company match)
• We offer generous paid time off for our non-exempt team members, starting with 3 weeks + 13 paid holidays, including 2 personal floating holidays. We also offer flexible time off for our 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

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed
• Number of Employees: 1,001-5,000 employees