Senior Operations Analyst

Job Description

Essential Functions (Duties and Responsibilities): 75% Resolve outstanding health insurance claims or documentation issues through analysis and co-ordination with relevant teams. Communicate with payers effectively and/or adhere to payer guidelines to achieve timely determinations. Perform tasks or related responsibilities and achieve desired output on specified process in healthcare RCM. Achieve desired quality of service as required by standard operating procedure and support in continuous performance improvement to offer best quality services. Responsible to maintain important logs and documentation regarding the details of the tasks performed. Support an environment of accountability and management against goals. Collaborate with cross-functional teams to resolve issues identified from day to day working of claims. 15% Identify and quantify work trends. Propose solutions to improve internal processes to facilitate a touchless revenue cycle. Work with internal teams across the Operations Division to prioritize and implement process improvements appropriately prioritized based on impact and business need. 10% Accept full ownership and responsibility for special projects Work with internal stakeholders and client-facing teams to identify and resolve claim issues impacting individual clients and/or discrete lines of business. Communicate effectively the status and resolution of any special projects, adhere to established timelines, and serve as a valued subject matter expert for internal teams. Education & Experience Required: Bachelor's degree or equivalent (Life science background) 3-6 years experience in fast paced environment Solid understanding of Anatomy & Physiology Comprehensive understanding of medical terminology Prior experience in processing multispecialty authorizations including contact with payers. Willing to work in the night shift. Knowledge & Skills: Healthcare RCM knowledge, preferred. Analytical skills and good communication skills Ability to clearly articulate actions taken and articulate next steps. MS office skills, required.