Waystar
Sr Enterprise Rules and Edits Consultant
Join to apply for the
Sr Enterprise Rules and Edits Consultant
role at
Waystar What You'll Do This cross-functional position will work with product, client support and technical teams to deliver accurate, timely claim edit/authorization rule configurations. Study healthcare industry standards and stay up-to-date on industry changes and compliance issues, focusing on government/payer requirements for claims billing and coding/authorization. Leverage analytical tools (Excel, PowerBI, SQL Databases) to identify trends and outliers in EDI 837/835/278 transaction data. Transform data and design new payer edits based on a client’s payer mix and facility types. Serve as subject matter expert in claim edits and payer policies; advise onboarding clients on optimizing claim rules and edits to prevent rejections and denials while reducing pended claim volume. Participate in project scoping and planning to design client-specific rule and edit recommendations. Partner with product and technology teams to prioritize and deliver new functionality to meet the rule, edit, and claims reporting needs of onboarding clients. Clearly communicate Waystar’s rule and edit capabilities and value to clients during implementation. Analyze previous vendor rule and edit configurations for parity, configure new rules and edits to fill any gaps. Analyze parallel testing results to identify differences in expected vs. actual results and design new system logic to address gaps. Study trends in custom rule and report requests to prioritize product enhancements; serve as liaison to Product to implement needed enhancements. Other duties as assigned. What You'll Need 10+ years of experience in a healthcare setting Strong ability to discuss complex technical information and general revenue cycle operations Exceptional organizational and analytical skills to manage multiple priorities and deliver timely and accurate results Demonstrated problem solving and decision-making process Proficient in research investigation EDI 835/837/270/276/278, X12 structures, formats, and standards Strong process orientation, problem solving & troubleshooting skills, and a firm commitment to quality HIPAA regulation knowledge Healthcare terminology Proficient with Microsoft Office Suite Good written and oral communication skills; team player Experience with EDI and/or healthcare transactions required Ability to travel up to 20% Ability to communicate with all levels of hospital / physician business office personnel Preferred Knowledge Experience with Epic, Cerner, eCW, NextGen, Meditech and other PM/HIS systems Certified medical coder (CPC, RHIT, CPB, CCS, etc) Experience with Waystar EDI solutions About Waystar Waystar helps providers simplify healthcare payments and yield powerful results throughout the complete revenue cycle with a smart platform and better experience. Our platform combines cloud-based technology, robust data, and client support to streamline workflows and improve financials so providers can focus on patients and communities. We are committed to our values: honesty; kindness; passion; curiosity; focus; best work, always; making it happen; and joyful, optimistic & fun. Waystar products have won multiple Best in KLAS or Category Leader awards since 2010 and earned rankings from Black Book surveys since 2012. Our platform supports more than 500,000 providers, 1,000 health systems and hospitals, and 5,000 payers and health plans. For more information, visit waystar.com. WAYSTAR PERKS Competitive total rewards (base salary + bonus, if applicable) Customizable benefits package (3 medical plans with Health Saving Account company match) Generous paid time off: 3 weeks + 13 paid holidays; personal floating holidays; flexible time off for exempt roles Paid parental leave Education assistance opportunities and free LinkedIn Learning access Free mental health and family planning programs, including adoption assistance and fertility support 401(k) with company match Pet insurance Employee resource groups Waystar is an equal opportunity workplace. We value diversity and inclusion. Qualified applicants will receive consideration without regard to race, color, religion, age, sex, national origin, disability, genetics, marital status, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by law. Job Category:
Client Operations Job Type:
Full time Req ID:
R2783
#J-18808-Ljbffr
Join to apply for the
Sr Enterprise Rules and Edits Consultant
role at
Waystar What You'll Do This cross-functional position will work with product, client support and technical teams to deliver accurate, timely claim edit/authorization rule configurations. Study healthcare industry standards and stay up-to-date on industry changes and compliance issues, focusing on government/payer requirements for claims billing and coding/authorization. Leverage analytical tools (Excel, PowerBI, SQL Databases) to identify trends and outliers in EDI 837/835/278 transaction data. Transform data and design new payer edits based on a client’s payer mix and facility types. Serve as subject matter expert in claim edits and payer policies; advise onboarding clients on optimizing claim rules and edits to prevent rejections and denials while reducing pended claim volume. Participate in project scoping and planning to design client-specific rule and edit recommendations. Partner with product and technology teams to prioritize and deliver new functionality to meet the rule, edit, and claims reporting needs of onboarding clients. Clearly communicate Waystar’s rule and edit capabilities and value to clients during implementation. Analyze previous vendor rule and edit configurations for parity, configure new rules and edits to fill any gaps. Analyze parallel testing results to identify differences in expected vs. actual results and design new system logic to address gaps. Study trends in custom rule and report requests to prioritize product enhancements; serve as liaison to Product to implement needed enhancements. Other duties as assigned. What You'll Need 10+ years of experience in a healthcare setting Strong ability to discuss complex technical information and general revenue cycle operations Exceptional organizational and analytical skills to manage multiple priorities and deliver timely and accurate results Demonstrated problem solving and decision-making process Proficient in research investigation EDI 835/837/270/276/278, X12 structures, formats, and standards Strong process orientation, problem solving & troubleshooting skills, and a firm commitment to quality HIPAA regulation knowledge Healthcare terminology Proficient with Microsoft Office Suite Good written and oral communication skills; team player Experience with EDI and/or healthcare transactions required Ability to travel up to 20% Ability to communicate with all levels of hospital / physician business office personnel Preferred Knowledge Experience with Epic, Cerner, eCW, NextGen, Meditech and other PM/HIS systems Certified medical coder (CPC, RHIT, CPB, CCS, etc) Experience with Waystar EDI solutions About Waystar Waystar helps providers simplify healthcare payments and yield powerful results throughout the complete revenue cycle with a smart platform and better experience. Our platform combines cloud-based technology, robust data, and client support to streamline workflows and improve financials so providers can focus on patients and communities. We are committed to our values: honesty; kindness; passion; curiosity; focus; best work, always; making it happen; and joyful, optimistic & fun. Waystar products have won multiple Best in KLAS or Category Leader awards since 2010 and earned rankings from Black Book surveys since 2012. Our platform supports more than 500,000 providers, 1,000 health systems and hospitals, and 5,000 payers and health plans. For more information, visit waystar.com. WAYSTAR PERKS Competitive total rewards (base salary + bonus, if applicable) Customizable benefits package (3 medical plans with Health Saving Account company match) Generous paid time off: 3 weeks + 13 paid holidays; personal floating holidays; flexible time off for exempt roles Paid parental leave Education assistance opportunities and free LinkedIn Learning access Free mental health and family planning programs, including adoption assistance and fertility support 401(k) with company match Pet insurance Employee resource groups Waystar is an equal opportunity workplace. We value diversity and inclusion. Qualified applicants will receive consideration without regard to race, color, religion, age, sex, national origin, disability, genetics, marital status, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by law. Job Category:
Client Operations Job Type:
Full time Req ID:
R2783
#J-18808-Ljbffr