The Manager Claim Analytics role is an integral part of the overall financial plan for LucidHealth.  This position supports the data needs of the national Revenue Cycle presence and is also called upon to study the outcome of claims that have achieved a zero balance.  While the main internal customer is the Revenue Cycle service area, the position may be offered to support other strategic needs and initiatives as well.  LucidHealth is excited to present the opportunity to an individual who is idea-centric, goal-oriented, accountable and prides themselves in doing what others say cannot be done.  The position has first-level interactions with the Director Payor Relations and also the Vice President of Revenue Cycle.  This role is essential to help various stakeholders in the organization interpret data outcomes so that revenue opportunities can be achieved.   

PRIMARY RESPONSIBILITES

• Establish a regular protocol to identify claims that have achieved a zero balance and isolate the payments, adjustments and other essential components of the transaction history for the purpose of understanding those claim behaviors.  

• Summarize the behavior of those zero claims by major payor group, specific insurance plan and also to the group level within insurance plans as needed.

• Serve as a subject matter expert on custom report writing, data warehouse and data lake functions within and connected to Revenue Cycle.  

• Provide custom report writing as needed to monitor and quantify transactional activity associated with Specialty Vendors who also serve Revenue Cycle needs.

• Provide direct support and feedback to Revenue Cycle leaders where data needs exist and work with the Director Payor Relations and Vice President Revenue Cycle to prioritize those requests.

• Obtain an advanced knowledge or core Revenue Cycle platforms to further enhance information and outcomes.

• Drive excellence by assuring the highest quality of output reporting within the Revenue Cycle and other areas called upon for support.

ADDITIONAL RESPONSIBLITIES

• Attend various internal meetings to gain knowledge of Revenue Cycle operational needs and challenges.

• Offer feedback, guidance and recommendations into areas of need based upon knowledge and/or experience.

• Assist internal leadership within Revenue Cycle by interacting with other software vendors as needed. 

• Publish a monthly internal report on activities for executive leadership.

• Assuring, documenting and returning value to the organization in excess of the compensation package.

KEY LEADERSHIP SKILLS AND INITIATIVES

As a leader of people, the role requires a focus on delivering outcomes that are set by the organization.  As such, with all decision making in the role, the individual must demonstrate, attain and deliver on the concepts described.  

Drives Initiatives – getting behind those workplace goals and enhancements through engagements with your team(s) and also other colleagues within the organization.  These initiatives also will typically involve our Specialty Vendor partners who would also be supporting those workplace goals and enhancements.  Everyone in the team(s) must see the leader’s engagement and be inspired to participate accordingly.

Improves Team Engagement – sharing goals and techniques with your team(s) and promoting the various initiatives in a positive manner.  Encourage participation and input from all team members and also encourage those team members to provide services outside of their primary scope of work as resources would allow.  It is imperative that the leader give the team a voice in our workplace by encouraging open and uninhibited communication in a professional method.  

Maintains Compliance and Contractual Obligations – as a healthcare service provider, we must always be attentive to compliance and ethics in the functions of our work.  All team members must understand and appreciate the need for our compliance protocols and be encouraged to ask questions, cite concerns and ask for clarification whenever a matter arises.  We also require high ethical standards in all of our business activities and practice integrity.  We do not look for ways to minimize our compliance, ethical or integrity standards, we apply those standards in our daily work with pride.

KNOWLEDGE AND SKILL REQUIREMENTS

• A minimum of seven years of occupational experience in the financial side of the healthcare sector with an emphasis on Revenue Cycle, analytics, custom report writing and data management.  

• A bachelor's degree in a related field of study.’

• Proficiency in correspondence, presentations and other communication methods.

• Ability to partner with various stakeholders and facilitate collaboration therein.

• Serve as a change agent, where needed, focusing on what can be done rather than what cannot or hasn’t been able to be done.

• Demonstrating and practicing a sense of urgency with work responsibilities.

• A preference for proficiencies in data science (including SQL, Alterix, PowerBI) to facilitate data extraction.