Medical Bill Review Specialist (Claims Operations Business Analyst)

Summary:  Under limited supervision and with significant independent judgment, leverages data, technology and resources to provide tools designed to optimize profit and growth, and enhance decision making and/or operational efficiencies.

Essential Duties and Responsibilities:

1. In cooperation with leadership, ensures departmental best practices by:
1. Researches, develops, and implements reporting tools
2. Provides validation of results, analysis and recommendations to management based on results from the reporting tools
3. Recommends and communicates system and data enhancements
4. Develops and delivers training related to projects, data and/or reporting tools
5. Serves as the subject matter expert, providing reporting tool expertise on department and cross-functional teams
6. Monitors the performance of external vendors and/or employee work (through internal audits) to ensure adherence to standards

1. Serves as Business Lead and/or resource on complex corporate projects representing departmental function

1. May provide leadership to junior staff through guidance and training

1. Performs other duties as assigned

Education/Experience:

Level 5:   Bachelor's degree (B.A.) from four-year college or university, or four to six years related experience and/or training; or equivalent combination of education and experience.

**Medical Coding Certificate preferred but not required.