NOTE: This position requires eight days a month in office at a specified Wolters Kluwer location.
Preferred Location: Riverwoods, IL (USA)
About the Role:
We are seeking a highly skilled Business Analyst to join the Mediregs team focusing on claims processing and the RCM process. The ideal candidate will have a strong understanding of healthcare reimbursement systems, RCM (Revenue Cycle Management) software and systems, and be proficient in analyzing CMS rules as it relates to claims and processes. The candidate will be able to express this domain knowledge by creating requirements, test cases and use cases.
As a key member of the Product Management team, you will manage functional requirements and use-cases for enhancing our content, claims calculators and other software solutions. You will participate in all stages of functional development: designing solutions, implementation, testing and documentation; as well as contribute to software maintenance and final acceptance testing.
The Business Analyst works closely with a cross-functional team of application designers, developers, quality assurance, product managers, and customer unit stakeholders to document requirements and plan enhancements based on existing knowledge and research. The candidate participates in all agile ceremonies.
The candidate will be encouraged to document and share knowledge and experience across the team, contribute to onboarding new team members and support the broader team in ensuring we deliver for our customers.
Additional Information: https://www.wolterskluwer.com/en/solutions/mediregs
Key Responsibilities:
- Research, analyze and interpret CMS rules and claims data to identify trends, issues, and changes. This includes researching and understanding provisional and final rules as published by CMS and modifying requirements for software solutions based on changes.
- Conduct data analysis to ensure our systems provide accurate and timely claim submission analysis for our clients.
- Participate as part of a cross-functional team in developing and maintaining reports and dashboards to monitor claims performance and compliance that provide actionable insights for our customers.
- Provide training and support to team members on OPPS and IPPS claims processes.
- Stay updated on changes in healthcare regulations and reimbursement policies.
- Collaborate with cross-functional teams in agile ceremonies and story grooming.
Qualifications:
- 3+ years as a Medicare/Medicaid Compliance Analyst - Revenue Cycle
- 1+ years of EHR or homegrown EMR implementation experience
- 3+ years of claim submission experience Inpatient preferrable; Outpatient required
- 3+ years of experience writing functional requirements and creating use cases .
- 3+ years Business Analyst experience .
- Strong analytical and problem-solving skills.
- Excellent communication and interpersonal skills.
- Ability to work independently and as part of a team.
- Proficiency in data analysis tools (e.g., SQL, Excel, Tableau).
- Recent experience with healthcare claims software (e.g., Epic, Cerner, or equivalent).
Preferred Skills
- Preference given to those with experience using CMS FFY and April updates to craft requirements and test/use cases .
- Preferred recent progressive RCM experience at a hospital or clearinghouse .
Travel - Less than 20%
