Rule Operations Analyst

4 days ago

Remote, Oregon, United States Revecore Full time $60,000 - $100,000 per year

Revecore is an innovative, technology-driven company that is committed to helping our clients, our employees, our

company, and our communities thrive. An award-winning services firm, partnering with hospitals and health systems,

providing the momentum they need to maintain a strong revenue cycle amid today's evolving healthcare environment.

With a 20+ year history, Revecore is the leading provider of revenue integrity and complex claims solutions for hospitals.

We offer a dynamic and flexible work environment, full of opportunity for motivated, hands-on team players. We strive

each day to solve complex business problems and find new ways to enhance the efficiency, effectiveness, and quality of

our services. If those attributes resonate with you, regardless of where you are located—we want you on our team

Purpose:

Rule Operation Analysts are rule owners and have responsibility for the accuracy and performance of their rule

portfolio. They monitor the performance of rules, research underperforming rules, identify changes to optimize and

improve effectiveness, and coordinate the execution of changes. They report results to operational leaders based on

projected and realized results and interface with technical consultants to maximize accuracy. They also have the

responsibility to identify broader applicability of rules and communicate with the appropriate leaders and other strategic

partners. They have specific goals to maintain and improve performance of their rule portfolio.

Duties and Responsibilities

  • Build strong, lasting relationships with R&D and other cross functional teams supporting Rule Operations.
  • Engage with operational leaders to support their business through effective utilization of rules to maximize results.
  • Manage portfolio of rules through analysis of EV and other data science outputs to identify improvements which will maximize

results.

  • Collaborate with other cross functional teams to understand changes to features and attributes that will improve results.
  • Document rule improvements for underperforming and inaccurate rules based on EV projected and realized results.
  • Communicate changes and recommendations to leaders and demonstrate the value of improvements.
  • Execute recommendations through updates to rules and monitor outcomes.
  • Attend and participate in department and other Revecore meetings.
  • Comply with federal and state laws, company and department policies and procedures.
  • All other duties as assigned

Skills and Experience

  • Bachelor's Degree in a Healthcare related field is preferred but not required.
  • Advanced computer proficiency with MS Excel and other Microsoft products is preferred.
  • Experience with SQL is helpful but not required.
  • Ability to research and investigate related information using the internet, payor websites, and other industry

related resources and tools.

  • Strong problem-solving skills to understand data patterns that help define problems, provide data, establish

facts, and draw valid conclusions which lead to leading to productive outcomes.

  • Strong critical thinking skills to Ability to read and interpret industry related documents contracts, claims,

instructions, policies, and procedures in written (in English) and diagram form

  • Ability to present ideas on complex, detailed issues with ease
  • Strong analytical, troubleshooting and problem resolution skills
  • Strong communication skills, written and verbal
  • Strong customer service orientation
  • Excellent interpersonal and communication skills
  • Strong team player
  • Commitment to company values

Requirements:

Rule Operations Analyst

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