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Summary:
In this role, you will lead complex healthcare revenue cycle analytics supporting client engagements focused on chargemaster optimization, pricing, reimbursement, claims, and financial performance. You will analyze large and complex datasets, develop analytical solutions, and translate findings into actionable recommendations. You will apply expertise in healthcare billing, reimbursement, and revenue cycle operations to identify opportunities, validate results, and deliver insights that support client and business decisions.
Responsibilities:
- Analyze client data and issues involving chargemaster structure, revenue codes, CPT and HCPCS codes, modifiers, billing units, pricing, reimbursement, and charge accuracy.
- Evaluate healthcare pricing and reimbursement methodologies to identify opportunities to improve consistency, transparency, and financial performance.
- Review chargemaster, pricing, claims, remittance, payer contract, adjustment, denial, underpayment, and payment data to identify trends and improvement opportunities.
- Analyze national claims and benchmark data to assess client pricing, utilization, reimbursement, billing practices, payer performance, procedure trends, and revenue opportunities.
- Develop financial models, dashboards, reports, and recurring analytics that support client recommendations and business decisions.
- Write, troubleshoot, and optimize complex SQL queries to extract, join, cleanse, aggregate, and validate data across multiple healthcare data sources.
- Translate client business needs into technical requirements and analytical solutions, validating results against source systems, financial reports, claims data, and supporting information.
- Present analytical findings, insights, and recommendations clearly to consulting teams and other audiences.
- Document business rules, data definitions, analytical methodologies, assumptions, and reporting processes.
- Partner with client Finance, Patient Financial Services, Coding, Managed Care, Information Technology, Pharmacy, and other departments to support revenue cycle initiatives.
Qualifications:
- Relevant degree preferred.
- 7 or more years of relevant experience required.
- Advanced SQL skills and experience analyzing large, complex healthcare datasets preferred.
- Strong knowledge of healthcare revenue cycle operations, including chargemaster maintenance, pricing, billing, reimbursement, and claims analysis.
- Working knowledge of revenue codes, CPT and HCPCS codes, modifiers, billing units, payer reimbursement, contractual adjustments, denials, underpayments, and accounts receivable.
- Strong understanding of the pharmacy revenue cycle from order placement through billing, payment, reconciliation, and collections.
- Working knowledge of CMS policies and healthcare reimbursement requirements.
- Strong analytical, problem-solving, organizational, and written and verbal communication skills.
- Ability to manage multiple client engagements, prioritize competing deadlines, and work independently.
Estimated Hiring Range:
At Vizient, we consider skills, experience, and organizational needs in our compensation approach. Geographic factors may adjust the range estimate and hires typically fall below the top range. Compensation decisions are tailored to individual circumstances. The current salary range for this role is $77,400.00 to $135,400.00.
This position is also incentive eligible.
Vizient has a comprehensive benefits plan! Please view our benefits here:
http://www.vizientinc.com/about-us/careers
Equal Opportunity Employer: Females/Minorities/Veterans/Individuals with Disabilities
The Company is committed to equal employment opportunity to all employees and applicants without regard to race, religion, color, gender identity, ethnicity, age, national origin, sexual orientation, disability status, veteran status or any other category protected by applicable law.
