Rule Operations Analyst

at  Revecore

POSITION SUMMARY

Rule Operation Analysts are rule owners and have responsibility for the accuracy and performance of their rule portfolio. They monitor the performance of rules, research underperforming rules, identify changes to optimize and improve effectiveness, and coordinate the execution of changes. They report results to operational leaders based on projected and realized results and interface with technical consultants to maximize accuracy. They also have the responsibility to identify broader applicability of rules and communicate with the appropriate leaders and other strategic partners. They have specific goals to maintain and improve performance of their rule portfolio.

SKILLS AND EXPERIENCE

• Bachelor’s Degree in a Healthcare related field is preferred but not required.
• Advanced computer proficiency with MS Excel and other Microsoft products is preferred.
• Experience with SQL is helpful but not required.
• Ability to research and investigate related information using the internet, payor websites, and other industry related resources and tools.
• Strong problem-solving skills to understand data patterns that help define problems, provide data, establish facts and draw valid conclusions which lead to leading to productive outcomes.
• Strong critical thinking skills to Ability to read and interpret industry related documents contracts, claims, instructions, policies and procedures in written (in English) and diagram form
• Ability to present ideas on complex, detailed issues with ease
• Strong analytical, troubleshooting and problem resolution skills
• Strong communication skills, written and verbal
• Strong customer service orientation
• Excellent interpersonal and communication skills
• Strong team player
• Commitment to company values

• Build strong, lasting relationships with R&D and other cross functional teams supporting Rule Operations.
• Engage with operational leaders to support their business through effective utilization of rules to maximize results.
• Manage portfolio of rules through analysis of EV and other data science outputs to identify improvements which will maximize results.
• Collaborate with other cross functional teams to understand changes to features and attributes that will improve results.
• Document rule improvements for underperforming and inaccurate rules based on EV projected and realized results.
• Communicate changes and recommendations to leaders and demonstrate the value of improvements.
• Execute recommendations through updates to rules and monitor outcomes.
• Attend and participate in department and other Revecore meetings.
• Comply with federal and state laws, company and department policies and procedures.
• All other duties as assigned