Global Rules Optimization Associate

Join us as we work to create a thriving ecosystem that delivers accessible, high-quality, and sustainable healthcare for all.

Position Summary:

The Global Rules Associate will be responsible for identifying and transforming client and payer requirements into business logic our development team will utilize to create and maintain industry leading billing rules that generate superior results.  Requirements may be identified through client requests, internal insights, or data trends.

This individual has a combination of strong solution design skills, technical facility, analytical thinking skills, intense curiosity, and thrives on optimizing product and processes to maximize client value and operational efficiency.  This individual should have experience with revenue cycle, claim formatting, and billing requirements.  The Associate should demonstrate excellent communication skills, be detail oriented, understand how to manipulate and utilize large data sets, have a keen ability for solving business problems via independent analysis, and enjoy managing simultaneous projects with competing priorities and multiple stakeholders. 

About the Team:

The Global Rules Optimization (GRO) team empowers athenahealth to deliver industry-leading clean claim performance by implementing, influencing, and guiding upstream interventions that ensure the submission of clean claims with minimal work.

Essential Job Responsibilities:  

Analysis, Solution Design, and Project Management

• Research, design, and test claim billing logic to prevent claim rejections, denials, and billing work

• Grow and maintain athena’s library of insurance billing rules to minimize disruption to clients and internal teams

• Evaluate, prioritize, and act upon insights from clients, internal teams, and data to improve client and operational outcomes

• Management of and execution against problems of limited to moderate scope to research and improve specific areas of poor billing performance or drive process improvement

• Work effectively with stakeholders within and external to the GRO team to share billing expertise and collaborate on finding solutions to client needs.

• Analyze complex data sets, identifying trends and proactively developing solutions to globally felt customer issues

Education & Experience Required:

• Bachelor’s degree or 3-5 years of experience in an insurance or medical coding field

• Experience solving complex healthcare billing problems involving revenue cycle, claim formatting, and coding requirements 

• Certified Professional Coder (CPC) certification is a plus 

• Comfortable initiating payer calls and engaging directly with clients and internal athena stakeholders via phone to troubleshoot, clarify requirements, and provide exceptional service.

• Comfortable navigating and utilizing web and software applications, with a foundational understanding of cloud-based SaaS platforms and emerging AI technologies to enhance efficiency and innovation

Expected Education & Experience:

• Ability to assess large amounts of information, identify trends, and break information into key components

• Capable of transforming business requirements into logic statements

• Must be highly motivated and able to work independently as well as part of an extended, cross-functional team

• Understanding of the process of medical billing and medical terminology

• Excellent verbal and written communication skills

• Passion for customer service, problem solving, and solution design

• Ability to prioritize and to multi-task in a fast-paced environment, manage competing priorities and communicate potential conflicts to manager

• Capable of managing simultaneous projects with multiple stakeholders

• Maintain a curiosity on how things work and a willingness to dive deeper

 

Expected Compensation

$54,000 - $92,000

The base salary range shown reflects the full range for this role from minimum to maximum. At athenahealth, base pay depends on multiple factors, including job-related experience, relevant knowledge and skills, how your qualifications compare to others in similar roles, and geographical market rates.  Base pay is only one part of our competitive Total Rewards package - depending on role eligibility, we offer both short and long-term incentives by way of an annual discretionary bonus plan, variable compensatio