Rule Operations Analyst

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.

Duties and Responsibilities

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

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

Physical Demands and Work Environment

The physical demands and work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Physical Demands: While performing the duties of this job, the employee is occasionally required to walk; sit; use hands to handle or feel objects, tools or controls; reach with hands and arms; balance; stoop; talk or hear. The employee must occasionally lift and/or move up to 15 pounds. Specific vision abilities required by the job include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus.

Work Environment: While performing the duties of this job, the employee is exposed to weather conditions prevalent at the time. The noise level in the work environment is usually moderate.