Bill Review Process Analyst

Role Description

We are seeking a full-time, remote Bill Review Process Analyst. The Bill Review Process Analyst is responsible for analyzing Bill Review operational processes to identify and implement changes to improve performance on key performance indicators including productivity, reliability, quality, and efficiency.

The schedule for this position is Monday - Friday, 8 AM to 5 PM Central Time. This position may require travel 1-2 times per year.

Responsibilities include (but are not limited to):

• Data and System Support
  • Identify and resolve data issues for clients and vendors
  • Provide system testing and support for data reporting processes
  • Document and communicate solutions for system and customer-specific requirements
• Compliance and Bill Review Coordination
  • Coordinate internal audits and reviews with the Clinical Bill Review team
  • Collaborate with Bill Review leaders to implement process and system changes
• Process Improvement and Analysis
  • Lead and support process improvement initiatives focused on efficiency, quality, and cost savings
  • Analyze current processes and metrics to recommend and implement improvements
• Project and Change Management
  • Manage re-engineering and strategic projects, including UAT and stakeholder communication
  • Assist project and program managers with key initiatives and maintain process documentation
• Leadership and Security Compliance
  • Develop leadership skills and contribute to team strategy
  • Ensure compliance with information security policies and report incidents as required

Qualifications

• Bachelor's Degree in appropriate field of study or equivalent work experience
• Knowledge of process assessment and optimization techniques
• Proven working experience in project management and change management environment
• Excellent client-facing and internal technical communication skills
• Excellent written and verbal communication skills
• Solid organizational skills including attention to detail and multitasking skills
• Strong working knowledge of Microsoft Office and Visio
• Highly Preferred: experience working in claims processing systems, ideally in the Workers Compensation industry

Requirements

• Process mapping and documentation: experience with Visio, BPMN
• Data analysis and reporting: experience using Excel, Tableau, Power BI
• Process improvement methodologies such as Lean, Six Sigma
• Bill review process expertise: deep understanding of bill review workflows; ability to translate operational knowledge into process improvements
• Claims processing and medical billing: claims adjudication, medical billing coding (CPT, ICD-10, HCPCS) and regulatory requirements (work comp, PPOs)
• Healthcare regulations and compliance: experience with HIPAA, HITECH, Medicare/Medicaid
• Vendor management: manage relationships with external vendors and tech partners
• Stakeholder engagement: collaborate with bill review teams, SMEs, and leadership to understand workflows and drive change

Benefits

• Health and wellness – We offer PPO, HDHP, and HMO health insurance options with Cigna and Kaiser (CA employees only).
• Financial incentives – Competitive salaries, 401(k) matching contributions, employer-paid life and disability insurance, flexible spending and commuter accounts, and employer-matched HSA contributions.
• Vacation - Our paid time off and personal holiday programs give you the flexibility you need to live your life to the fullest.
• Volunteer time – Full and part-time employees receive one paid day per calendar year to engage with and give back to their communities.
• Learning and development – We support continual learning and growth through our Learning Excellence at Paradigm (LEAP) program.