Senior Operations Analyst

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.