Analyst, Strategic Operations

• Prepare, validate, and submit Independent Dispute Resolution disputes under federal and state requirements




• Confirm dispute eligibility and customize supporting evidence for each dispute




• Review claim, payer, and determination data for accuracy and completeness




• Resolve discrepancies before submission




• Facilitate payer escalations and drive cash collections on prior disputes through phone, written, and faxed follow-up




• Track payment status through resolution




• Develop standard operating procedures, training materials, and workflow documentation for escalation and collection activity




• Support vendor management by organizing documentation, coordinating contract and information requests, tracking deliverables, and monitoring vendor performance




• Develop and maintain reporting and metrics for the IDR program




• Surface trends in eligibility, determinations, payer behavior, and recovery




• Translate analytical results for non-technical audiences, executive management, and external partners




• Maintain knowledge of payer guidelines, state/federal regulations, and industry standards




• Collaborate with payers during disputes to reach mutually beneficial resolutions and improve payer relations




• Resolve data integrity and integration issues across departments




• Identify process, documentation, and tooling improvements and own assigned improvement projects




• Perform other duties as assigned




• Report to the Vice President of Strategic Operations (IDR)

Requirements

• Bachelor’s Degree in Healthcare Administration, Business, Finance, Economics or similar is preferred




• 0-2 years of work experience; internship, co-op, or coursework in healthcare, finance, analytics, or operations preferred




• Prior experience working with multiple systems and platforms




• Experience in a high-growth healthcare company preferred




• Experience with the Independent Dispute Resolution process under the NSA preferred; training will be provided




• Proven critical thinking and problem-solving skills, including working through ambiguous or undefined problems and recommending a course of action




• Excel proficiency, including pivot tables and VLOOKUP, and comfort working with large datasets




• Ability to work independently, manage competing priorities, and follow through on long-running items with limited direct supervision




• High attention to detail and excellent organizational skills




• Effective written and verbal communication with internal teams and external payer parties




• Negotiation and conflict-resolution skills to advocate for claim approvals




• Ability to interpret and apply payer policies, state/federal regulations, and compliance standards




• Proficiency in time management for high-volume workloads




• Ability to work effectively under deadlines and self-manage multiple projects simultaneously




• Experience with Salesforce preferred; exposure to Tableau or similar visualization tools a plus




• Proficiency with Microsoft Office Suite or related software




• Familiarity with healthcare compliance standards such as HIPAA and ability to maintain confidentiality




• Interest in learning a complex and rapidly evolving regulatory area




• Ability to thrive in a high-growth, fast-paced organization and 100% remote-based environment




• Must be able to remain in a stationary position 50% of the time

Core Competencies

Demonstrates expertise in Independent Dispute Resolution processes, payer guidelines, and healthcare compliance standards while effectively managing multiple projects and priorities in a fast-paced environment. Proficient in data analysis, reporting, and communication to facilitate dispute resolutions and improve payer relations.

Highest-signal resume keywords

• Independent Dispute Resolution Process




• Excel Proficiency




• Healthcare Compliance Standards




• Negotiation and Conflict-Resolution Skills




• Data Analysis and Reporting

Hard Skills

• Data Analysis




• Reporting and Metrics Development




• Payer Policy Interpretation




• Process Improvement




• Critical Thinking




• Problem-Solving




• Attention to Detail




• Time Management




• Workflow Documentation




• High-Volume Workload Management

Soft Skills

• Effective Communication




• Organizational Skills




• Ability to Work Independently




• Collaboration




• Adaptability

Industry Keywords

• Healthcare Administration




• Payer Relations




• State/Federal Regulations




• HIPAA Compliance




• High-Growth Healthcare Company

Tools & Technologies

• Salesforce




• Microsoft Office Suite




• Tableau




• VLOOKUP




• Pivot Tables