"Alerted.org

Role Overview:

The Enterprise Operations Solutions Analyst is a subject matter expert and analyst on all research and analysis of provider claim issues and escalated complaints that are referred by state agencies, plans, providers, or other departments.;

; **Work Arrangement:**

+ Remote - Associate can work remotely anywhere in the United States.

+ Some travel may be needed for business meetings.

; **Responsibilities:**

+ Responsible for supporting business processes and practices for all Lines of Business

+ May need to support critical efforts outside of normal business hours, dependent on department need

+ Function as a key subject matter expert for all research and analysis of provider claim payment issues

+ Identify and present root causes and recommended corrections for complex operational claim payment problems that may result in policy changes, provider education, and system configuration changes.

+ Develop and maintain tracking mechanisms to identify and address provider claim issues and escalated complaints through remediation.

+ Analyze trends related to claim experience to identify potential issues before they arise proactively.

+ Inform and influence the claims process for new initiatives or services.

+ To effectively provide technical expertise, the employee must maintain a current working knowledge of processing rules, contractual guidelines, plan policy, and operational procedures.

+ Develop business models and documentation to support business decisions, workflows, and processes.

+ Focus on technology and business issues and communicate appropriately with technology and business experts.

+ Utilize various technology applications to track, trend, and store information related to claims processing, provider maintenance, and member eligibility.;

+ Build business cases that will enable business and technology change based on requirements.

+ Act as a liaison and participate in defining, conveying, and documenting business requirements to solve complex claims issues, business issues, or problems.

+ Provide documentation for requirements, meetings, changes, interfaces, reports, and overall workflow.

; **Education & Experience:**

+ Bachelor’s Degree or equivalent experience.

+ 2 to 3 years of healthcare experience with claims, encounters, and/or research and analysis.

+ Billing and coding experience is a plus

+ Extensive claims payment knowledge with critical thinking skills.

+ Strong with Microsoft Office Suite (Excel, Access, Word), and SQL

; **Skills & Abilities:**

+ Ability to establish and maintain effective relationships with all levels of the organization.

+ Strong ability to multitask and address various lines of business regarding the status of efforts and business responsibilities.

+ Ability to communicate effectively with all levels of associates up through executive management;

;

As a company, we support internal diversity through:

Recruiting. We are an equal opportunity employer. We do not discriminate on the basis of age, race, ethnicity, gender, religion, sexual orientation, or disability. Our inclusive, equitable approach to recruiting and hiring reinforces our commitment to DEI.