Business Consultant

Overview

The Business Consultant leads and mentors the Service Delivery team in all Tier 1 (Basic) and Tier 2 (Intermediate) consulting initiatives. The position provides in-depth and comprehensive subject matter expertise related to Burgess products (from basic to advanced features/functionality), payment methodologies/policies (Medicare, Medicaid, and commercial), payment integrity, and healthcare plan operations (e.g., claim life cycle/workflow, network contracting, payment/policy configuration, provider relations, medical management, medical economics, audit, compliance) related to implementation/consulting engagements, strategic user adoption initiatives, and ongoing client support.

What you will do

• Educate and provide in-depth subject matter expertise related to: Medicare, Medicaid, and commercial payment methodologies/policies, payment integrity, and healthcare plan operations (e.g., claim adjudication life cycle/workflows, network contracting, payment/policy related configuration, provider relations, medical management, medical economics, audit, compliance).
• Manage and/or participate in the development, maintenance, and execution of client facing education services.
• Enhance/issue escalation, manage issues, questions, inquiries of Tier 1 and 2 escalation, serve as escalation point for critical client needs as warranted.
• Lead diagnosis and resolution of escalated and more involved/complex client problems and issues.
• Partner with appropriate Burgess Teams (BA, PM, Development, Account Management, Sales/Business Development, Product, Content, and Service Delivery) to manage problem framing, diagnosis and resolution.
• Conduct/ participate in root cause analysis to identify and deliver warranted service improvements.
• Staff/Team Management/Supervision, mentor and provide oversight for Tier 1 and 2 Service Delivery staff.

What You Bring

• Bachelor’s degree in a business, health services administration, mathematics, science or related field, and/or equivalent work experience required.
• AHIP, HFMA, AAPC, and/or AHIMA certification preferred.
• 5+ years training, education, and/or consulting experience preferred.
• Practical understanding of the healthcare system with regards to Medicare, Medicaid, managed care, and commercial payment methodologies, payment integrity, and health plan operations (e.g., claim life cycle/workflows, network contracting, payment/policy related configuration, provider relations, medical management, medical economics, audit, compliance).
• Experience with interpretation/translation of complex health-plan in-network and out-of-network provider rate and/or claim editing provisions.
• Experience with configuration and maintenance of provider rate and/or claim editing provisions in a claims adjudication system and/or third-party vendor application.
• Working knowledge of claim billing specifications (e.g., CMS-1500, UB-04, 837, HIPAA code sets).
• Creative problem-solving skills including the ability to identify, recommend, and implement strategic solutions.
• Ability to manage issues, requests, problems, and situations of all Tier 1 and 2 escalation levels.
• Demonstrated ability to conduct education/training sessions to large audiences across multiple skill levels.
• Strong analytical skills.
• Excellent organizational skills.
• Excellent communication (both written and verbal) and interpersonal skills.
• Ability to learn and adapt to new technologies and systems.
• Ability to adapt to a changing and rapidly growing environment.
• Effectively manage multiple priorities and follow through on all projects to completion.

Who You Are

• Creative entrepreneur.
• Critical, big-picture thinker.
• Self-starter.
• Team player & coach.
• Adaptable multi-tasker.

How We Work

• Collaborative.
• User-driven.
• Hands-on.
• Impact over ego.
• Forward-looking.
• Caring & close knit.

Geographic Responsibility

Remote, US

Type of Employment

Full-time, permanent

FLSA Classification (USA Only)

Exempt

Work Environment

• The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job: The employee is occasionally required to move around the office.
• Specific vision abilities required by this job include close vision, color vision, peripheral vision, depth perception, and ability to adjust focus.
• Work across multiple time zones in a hybrid or remote work environment.
• Long periods of time sitting and/or standing in front of a computer using video technology.
• May require travel dependent on company needs.