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 Source 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. 

The Product: 

With Source, we’re changing the industry narrative, providing a more holistic approach to payment integrity that focuses on comprehensive reimbursement, agile editing, and integrated analytics. Our interoperable, cloud-based solution is modular to meet a health plan’s needs today and extensible to grow with their organization over time—bringing disparate parts of a payer’s organization together for improved accuracy and insights. The Source platform offers the ability for clients to unlock transformation at the reimbursement, payment integrity, and enterprise level. Our Reimbursement Transformation features Medicare and Medicaid content coupled with flexible contract configuration capabilities for Commercial lines of business. Payment Integrity Transformation includes rich editing libraries with history-based capabilities, easy development of customized edits, and improved transparency to reduce vendor dependency and increase control. As a complete solution, clients can achieve Enterprise Transformation, where root-cause issues are identified and addressed upstream, and all aspects of claims operations are centralized for comprehensive business intelligence. The complete suite of solutions from HealthEdge delivers a digital foundation for payers specifically designed to fuel a digital transformation, reduce costs, and improve both clinical outcomes and the member experience. 

Who you are: 

• Creative entrepreneur. You have a constant drive to make things better; you question the status quo and approach common challenges with creativity and constructive criticism. You have skills to clearly and convincingly share ideas in a way that adapts to your audience, regardless of function, level, or expertise. 
• Critical, big-picture thinker. You have a constant thirst for knowledge and the ability to credibly share it with others, whether internally or externally. You are analytical, evaluating logic-based details while always considering and problem solving for the sake of the big picture. 
• Self-starter. You are proactive, self-motivated, and able to push work, start initiatives, and provide ideas independently in a team environment. 
• Team player & coach. You can foster professional and personal respect from others and find success in a team setting. While highly collaborative, you have natural management skills and know how to grow and develop people. 
• Adaptable multi-tasker. You are highly organized and flexible. You know how to manage expectations and are able to thrive in fast-paced, constantly changing environments and successfully adapt to a variety of tasks. 

What you will do: 

Education and Consulting (implementation/consulting engagements, strategic user adoption initiatives, and on-going client support) 

• Provide the highest level of product education (from basic to advanced features/functionality to Source end-users 
• Provide in-depth and comprehensive subject matter expertise related to: 

• Medicare, Medicaid, and commercial payment methodologies/policies 
• Payment integrity 
• Healthcare plan operations (e.g., claim adjudication life cycle/workflows, network contracting, payment/policy related configuration, provider relations, medical management, medical economics, audit, compliance) 

• Conduct collaborative scoping sessions to identify client needs and appropriate solutions 

• Actively manage and/or participate in the development, maintenance, and execution of client facing education services  

Enhancement/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. 
• Act as a liaison between clients and internal support staff (research, development, and product teams) to assure accurate problem interpretation and resolution. 
• Capture and solicit issues/feedback from clients and internal stakeholders and document issues and client impacts. 
• Partner with appropriate Source 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. 
• Maintain demeanor as a calming influence during pressure situations, mixing in the correct degree of professional assertiveness without becoming aggressive. 
• Maintain communication with customers during the problem resolution process, utilizing superior customer service skills. 

Capability/Tool Development/Maintenance 

• Leverage capabilities and tools (knowledge libraries, workflow, issue identification and documentation, function processes). 
• Lead capability and tool development under direction of Service Delivery Leadership. 

Staff/Team Management/Supervision 

• Mentor and provide oversight for Tier 1 and 2 Service Delivery staff 
• Take direction from and collaborate with Service Delivery Leadership to continually review and enhance performance and strategy. 

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. 

HealthEdge commits to building an environment and culture that supports the diverse representation of our teams. We aspire to have an inclusive workplace. We aspire to be a place where all employees have the opportunity to belong, make an impact and deliver excellent software and services to our customers. 

Geographic Responsibility: While HealthEdge is located in Burlington, MA you may live anywhere in the U.S. 

Type of Employment: Full-time, permanent 

Travel%:  10% 

FLSA Classification (USA Only): Exempt 

Budget/Revenue Responsibility: None 

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. 

The above statements are intended to describe the general nature and level of the job being performed by the individual(s) assigned to this position. They are not intended to be an exhaustive list of all duties, responsibilities, and skills required. HealthEdge reserves the right to modify, add, or remove duties and to assign other duties as necessary. In addition, reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position in compliance with the Americans with Disabilities Act of 1990.  Candidates may be required to go through a pre-employment criminal background check. 

HealthEdge is an equal opportunity employer. We are committed to workforce diversity and actively encourage all qualified persons to seek employment with us, including, but not limited to, racial and ethnic minorities, women, veterans and persons with disabilities. 

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