Job type:
6months +
Enclipse Corp.
flag_no USA

Project description:
This project is archived and not active any more.
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Pasadena, CA 91103

6months +

2 Openings

Revenue Cycle Analyst

The Solution Consultant within the CLIENT-IT Revenue Cycle Delivery Team program at Client leads solution planning, analysis and design efforts for related projects.

The Solution Consultant is responsible for understanding the strategic direction, priorities and needs of our business partners, as well as designing and facilitating the delivery of IT-based solutions to meet these needs. As a Solution Consultant you will prepare, present and collaborate on all required deliverables with the technical solutions project team; analyze and evaluate hardware, software, tools and related processes required to support proposed solutions; and develop preliminary solution architectures. Additionally you must develop alternative design solutions and design high-level network models; and utilize enterprise standard process methodology and tools. You will also be responsible for assisting business partners in developing their testing approach and plans, and in working as part of the technology testing team to plan and execute testing, to ensure both functional and non-functional requirements are met.

The CLIENT-IT Revenue Cycle program will improve the comprehensive, program-wide revenue cycle capabilities to achieve strategic goals, in particular, the successful implementation and support of self-funded and deductible products. The Initiative will help CLIENT achieve revenue collection goals, obtain the benefit of new information systems, and maintain regulatory compliance. Objectives of the Revenue Cycle program are to:

Support Client's growth strategy
Enable self-funded and deductible products
Contribute to the financial imperatives for cost structure improvements
Ensure appropriate reimbursement from non-dues revenue sources on a timely basis
Leverage CLIENT HealthConnect for documentation and coding
Sustain a high compliance standard

Client's Revenue Cycle program supports all regions in driving toward consistent implementation/configuration, where possible, of Resolute, ePremis and Ingenix. This includes designing a sustainable revenue cycle model to achieve the above objectives.

Billing systems are not consistent or efficiently performed throughout the organization. Regional and functional area solutions vary by payor/financial class for CLIENT covered members, members with other plans (eg Coordination of Benefits, Other Coverage Information) and non-members who may have government or other commercial plans, or who may qualify for third-party or ClientMedical Financial Assistance programs. These inconsistencies and inefficiencies across the organization result in increased claims, increased A/R days, lost 3rd party reimbursement on uncovered services, increased bad-debt from self pay, less than optimal verification of patients eligible for CLIENT MFA (Charity Care), and an inability to consistently and accurately collect patient liabilities at the point of service.
Position Summary

This is a technology position, but requires a business-focused background. This role will work closely with our business partners and information technology professionals. As a solutions consultant within this area you will be responsible for understanding the strategic direction, priorities, and needs of our business partners. With this understanding, you will design and facilitate IT based solutions that meet the needs of our clients while adhering to Client's National Systems Strategy. Solutions may be internally developed, vendor supplied or a combination of each.

Solutions Consultant Responsibilities:

Leads the collaboration with our business partners to define requirements, determine solution alternatives, and develop high-level designs and estimates
Leads the definition and concept phases of projects, but remains involved thereafter to ensure alignment with designed and accepted solutions through testing, production and support.
Collaborates with Enterprise Architecture to align designs with the National Systems Strategy (NSS), assess IT impacts and risks, and provide overall management for application/data/technical architectures.
Develop application architecture(s) for the applications, and migration strategies to support the evolution of the applications to meet business needs.
Stays involved in the entire life cycle to support preparation and execution of test scripts to ensure project delivery based on requirements defined
Provide customer support as required to meet service level agreements
Build and manage a cohesive team to meet deliverables per project/tracks assigned

Basic Qualifications for this Role:

6 or more years of industry experience that may include business/systems architecture, professional services consulting and software development
Bachelor's degree in related disciplines or 4 additional years of relevant experience
2 or more years of recent Health Care IT experience in a variety of Health Care provider and/or payer applications
Experienced in complex integrated systems planning and solution alternative analysis and design and delivery
Solid understanding of solution delivery life cycle of enterprise solutions, including experience in business process analysis, requirement elicitation and analysis, software and vendor selection, custom development and/or package implementation, testing and vendor management
Experienced in definition of application target architectures and strategies to evolve technology applications to support stated and future business needs
Experienced in IT consulting with focus on delivery of complex enterprise integrated solutions
Excellent communicator with strong customer focus with ability to work with business executives as well as technologists to elicit business requirements and articulate technology options
Excellent problem solving, decision making and negotiation skills
Team oriented and ability to work in a Matrix environment

Preferred Additional Qualifications:

Experience in systems supporting patient billing, healthcare financial management or accounting. Health Care industry experience with deep domain knowledge in health insurance new product development.
Working knowledge in the systems supporting: claims, charge capture, adjudication, patient eligibility, collection, membership interaction, coordinated benefits and the Epic suite of applications.
MS or MBA degree preferred
Hands-on experience in healthcare

Top 3-5 required skills:

Revenue cycle/patient financial services/patient accounting/claims, EHR implementation, system integration, system analysis & design

Top 3-5 daily responsibilities:

Deliverable driven - requirements, analysis, design, architecture, documentation

Desired skills:

Epic, web design/development, SOA, web services, X-12/HL-7, RUP, business/end-user interaction

Type of background you are looking for:
Health IT, business analysis, system analysis/design/development, technical documentation, SDLC

Soft skills: Verbal & written communications, self starter, team player, multitasking

Size of the team: Cross functional teams with various sizes

Information on the project:

Candidate will be assigned to various projects (eg, new guarantor statement implementation, new on-line functionality, various PFS projects)