Global Rules Optimization Associate

About This Role

The Global Rules Optimization Associate identifies and translates client and payer requirements into business logic for billing rules, driving superior results and minimizing claim rejections and denials. This role focuses on optimizing healthcare billing processes and maximizing client value through analytical thinking and strong solution design.

Responsibilities

• Research, design, and test claim billing logic to prevent rejections, denials, and billing work
• Grow and maintain athena's library of insurance billing rules
• Evaluate, prioritize, and act upon insights from clients, internal teams, and data to improve outcomes
• Manage and execute projects to improve billing performance or drive process improvement
• Collaborate with stakeholders to share billing expertise and find solutions to client needs
• Analyze complex data sets, identify trends, and develop solutions for customer issues

Requirements

• Bachelor’s degree or 3-5 years of experience in an insurance or medical coding field
• Experience solving complex healthcare billing problems involving revenue cycle, claim formatting, and coding requirements
• Comfortable initiating payer calls and engaging directly with clients and internal stakeholders
• Comfortable navigating and utilizing web and software applications
• Foundational understanding of cloud-based SaaS platforms and emerging AI technologies

Qualifications

• Bachelor’s degree
• 3-5 years of experience in an insurance or medical coding field, including solving complex healthcare billing problems involving revenue cycle, claim formatting, and coding requirements

Nice to Have

• Certified Professional Coder (CPC) certification
• Ability to assess large amounts of information and identify trends
• Capable of transforming business requirements into logic statements
• Highly motivated and able to work independently as well as part of a cross-functional team
• Understanding of medical billing process and medical terminology
• Excellent verbal and written communication skills
• Passion for customer service, problem solving, and solution design
• Ability to prioritize and multi-task in a fast-paced environment
• Capable of managing simultaneous projects with multiple stakeholders
• Maintain curiosity on how things work and willingness to dive deeper

Skills

* Required skills

Benefits