Healthcare Business Rules Analyst

The candidate is responsible for handling mid-level support of custom developed accounts receivable software, independent research, and rule authoring. Rule authoring is a form of software development that includes complex computational analysis of system events, conditions, actions, sequencing, branch analysis, and chaining/recursion. Our current rules engine has hundreds of thousands of rules and millions of condition checks that require precise grouping and sequencing to ensure continuity of automated revenue cycle processes. Managing a robust and complex business rule set, as part of a team, includes functions similar to that of software development: debugging, troubleshooting, research, and new rule development.

Job Tasks

• Complete rule adjustments for allowables and charges
• Assist in troubleshooting application issues
• Create effective systems documentation
• Develop knowledge of the business and workflows
• Analyze logical conditional pathways to confirm expected results
• Determine business impacts on workflow and assist in the development of new workflows
• Interpret business requirements into technical specifications
• Develop on-going strategies for productivity improvements
• Analyze rules for logical completeness, correctness, and optimization
• Coordinate and prioritize multiple projects and deadlines
• Conduct independent research with technical staff and subject matter experts
• Recommend changes in testing methods as needed
• Communicate complex information simply
• Complete other assigned responsibilities
• Other Continuity of Operations Duties as assigned

Qualifications

• Minimum of 3 years of experience in healthcare software systems
• Bachelor’s degree in Health Information Management, Computer Science, MIS, Informatics preferred
• 1 year of claims processing and reimbursement policy experience or equivalent knowledge preferred
• Proficiency with Microsoft Office
• Proficiency querying Microsoft SQL Server or other relational database is a plus
• Knowledge of structured programming techniques and database methodologies is a plus

Req Benefits: We offer comprehensive insurance benefits for full-time employees, including but not limited to Medical, Dental, Vision coverages, along with 401(k) and ESOP (Employee Stock Ownership Program), and Vacation and Sick time.