Sr Enterprise Rules and Edits Consultant

ABOUT THIS 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.

• This cross-functional position will work with product, client support and technical teams to deliver accurate, timely claim edit/authorization rule configurations.
• 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, Power
  
  BI, 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
• Configuring system settings and options; plans and executes unit, integration and acceptance testing
• 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.

• Bachelor’s degree or 2-4 years of equivalent experience in healthcare setting
• You know how to execute and like to roll up your sleeves to get things done
• An understanding and knowledge of hospital revenue cycle workflows and the provider reimbursement process from patients and payers obtained either through direct experience in a healthcare setting or an RCM focused HIT company
• Problem solving skills; able to analyze a problem and design creative solutions
• Possess 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
• Medical claims coding certification preferred

Through a smart platform and better experience, Waystar helps providers simplify healthcare payments and yield powerful results throughout the complete revenue cycle.

Waystar’s healthcare payments platform combines innovative, cloud-based technology, robust data, and unparalleled client support to streamline workflows and improve financials so providers can focus on what matters most: their patients and communities. Waystar is trusted by 1M+ providers, 1K+ hospitals and health systems, and is connected to over 5K commercial and Medicaid/Medicare payers. We are deeply committed to living out our organizational values: honesty;

kindness; passion; curiosity; fanatical focus; best work, always; making it happen; and joyful, optimistic & fun.

Waystar products have won multiple Best in KLAS or Category Leader awards since 2010 and earned multiple #1 rankings from Black Book surveys since 2012. The Waystar platform supports more than 500,000 providers, 1,000 health systems and hospitals, and 5,000 payers and health plans. For more information, visit  or follow @Waystar on Twitter.

• 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 Linked In 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

Waystar is proud to be an equal opportunity workplace. We celebrate, value, and support diversity and inclusion. Qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, national origin, disability status, genetics, marital status, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.

This applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.

Job Category:
Client Operations

Job Type: Full time

Req : R2783