ABOUT THIS POSITION
This Senior Consultant, Enterprise Rule & Edits position reports to our Enterprise Rules & Edits Manager and has the responsibility for establishing new client payer edit configurations. The goal of the position is to ensure implementation clients exceed clean claim targets and report high satisfaction with Waystar edit processes and content. This will be achieved through active involvement in scoping, project planning, implementation, and stabilization. The Consultant will leverage billing and coding subject matter expertise and industry experience to advise clients in best practices and build a comprehensive payer edit library.The Consultant will partner with Client Operations, Client Success and Product to identify product enhancements that will improve client satisfaction and efficient use of resources.
WHAT YOU'LL DO
•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, PowerBI, SQL Databases) to identify trends and outliers in EDI 837/835/278 transaction data
• Transform data
Design new payer edits based on a new client’s payer mix and facility types
Subject matter expert in claim edits and payer policies
Advise onboarding clients on optimizing claim rules and edits to prevent rejections and denials while reducing pended claim volume
Participate in project scoping and planning to design a client-specific rule and edit recommendations
Partner with product and technology teams to prioritize and deliver new functionality to meet the rule, edit, and claims reporting needs of onboarding clients
Clearly communicate Waystar’s rule and edit capabilities and value to clients during implementation
Analyze previous vendor rule and edit configurations for parity, configure new rules and edits to fill any gaps
Analyze parallel testing results to identify differences in expected to actual results, design new system logic to address any gaps
Study trends in custom rule and report requests to prioritize for product enhancements
Serve as liaison to Product to implement needed enhancements
Other duties as assigned
WHAT YOU'LL NEED
10+ years of experience in a healthcare setting
Strength discussing both complex technical information and general revenue cycle operations
Exceptional organizational and analytical skills to manage multiple priorities and deliver timely and accurate results
Demonstrated problem solving and decision-making process
Proficient in research investigation
EDI 835/837/270/276/278, X12 structures, formats, and standards
Strong process orientation, problem solving & troubleshooting skills, and a firm commitment to quality
HIPAA regulation knowledge
Healthcare terminology
Proficient with Microsoft Office Suite
Good written and oral communication skills; team player
Experience with EDI and/or healthcare transactions required
Ability to travel up to 20%
Ability to communicate with all levels of hospital / physician business office personnel.
Preferred Knowledge
Experience with Epic, Cerner, eCW, Nextgen, Meditech and other PM/HIS systems
Certified medical coder (CPC, RHIT, CPB, CCS, etc)
Experience with Waystar EDI solutions
ABOUT WAYSTAR
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 waystar.com or follow @Waystar on Twitter.
WAYSTAR PERKS
- 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 LinkedIn 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.
Top Skills
What We Do
Waystar provides market-leading technology that simplifies and unifies healthcare payments. Our cloud-based platform streamlines workflows and improves financials for healthcare providers of all kinds, and brings more transparency to the patient financial experience.
The Waystar platform is used by more than 450k providers, 750 health systems and hospitals, and 5k health plans—and integrates with all major HIS and practice management systems.
The financial and administrative challenges facing healthcare providers are daunting. Waystar’s technology platform simplifies and unifies healthcare payments across the revenue cycle. We empower healthcare organizations to automate manual work, gain insight into processes and performance, and ultimately collect more revenue.
At Waystar, we know there’s a better, more efficient way forward. Let’s climb the mountain ahead of us to reach new heights in healthcare.
