ABOUT THIS POSITION
We are seeking an experienced Payer Authorization Rules and Claim Edits Director/Senior Director to lead a team of specialists responsible for ensuring that our organization stays up to date with changes in payer rules and regulations. The ideal candidate will have a deep understanding of medical claims processing and will be responsible for ensuring our clients are complying with payer rules and optimizing our claims edits library. In this role, you will develop and implement strategies to ensure support is provided at the highest level to maintain our top-tier KLAS ranking.
WHAT YOU'LL DO
WHAT YOU'LL NEED
- Lead and manage a team of specialists responsible for managing and maintaining a library of payer rules.
- Collaborate with other departments within the organization to ensure that claims are processed efficiently and accurately.
- Monitor changes in payer rules, partnering with payers to identify changes to claim submission rules and authorization requirements so that claims are processed accurately and efficiently.
- Analyze claims and denial data to identify trends and patterns, and update payer rules and edits accordingly.
- Develop and maintain relationships with payers to facilitate efficient communication and resolution of issues.
- Consult and interact with clients as needed to understand their requirements and ensure that their claims are processed accurately and efficiently.
ABOUT THE TEAM
- Bachelor's degree in healthcare administration, business administration, or a related field.
- At least 10 years of experience in medical claims processing, with a deep understanding of payer rules and regulations.
- Excellent analytical and problem-solving skills, with the ability to analyze claims data and identify trends and patterns.
- Strong communication and interpersonal skills, with the ability to effectively communicate with payers, clients, and internal stakeholders.
- Ability to lead and manage a team of specialists, prioritize tasks, and delegate responsibilities.
- Strong attention to detail and a commitment to accuracy.
- Familiarity with medical billing and coding systems.
- Experience with claims software and databases.
The Client Operations, Clearinghouse + Payment Operations, and Business Transformation team at Waystar builds brand loyalty and ensures solution adoption and client success. From resolving concerns to maintaining positive relationships, the team works directly with clients to provide resources and tools to help achieve their healthcare revenue cycle goals. The team is split into two divisions: Health Systems + Hospitals (HS+H) and Ambulatory. The Health Systems + Hospitals division includes large health systems at a multi-level local or national scale. The Ambulatory division includes organizations such as provider groups and physician and specialty practices.ABOUT WAYSTAR
Through a smart platform and better experience, Waystar helps providers simplify healthcare payments and yield powerful results throughout the complete revenue cycle.
Waystar's healthcare payments platform combines innovative, cloud-based technology, robust data, and unparalleled client support to streamline workflows and improve financials so providers can focus on what matters most: their patients and communities. Waystar is trusted by 1M+ providers, 1K+ hospitals and health systems, and is connected to over 5K commercial and Medicaid/Medicare payers. We are deeply committed to living out our organizational values: honesty; kindness; passion; curiosity; fanatical focus; best work, always; making it happen; and joyful,
Waystar products have won multiple Best in KLAS® or Category Leader awards since 2010 and earned multiple #1 rankings from Black Book™ surveys since 2012. The Waystar platform supports more than 500,000 providers, 1,000 health systems and hospitals, and 5,000 payers and health plans. For more information, visit waystar.com or follow @Waystar on Twitter.WAYSTAR PERKS
- Competitive total rewards (base salary + bonus, if applicable)
- Customizable benefits package (3 medical plans with Health Saving Account company match)
- Generous paid time off starting at 3 weeks + 16 holidays, including your birthday and volunteer time
- Paid parental leave (including maternity + paternity leave)
- Education assistance opportunities and free LinkedIn Learning access
- Free mental health and family planning programs, including adoption assistance and fertility support
- 401(K) program with company match
- Pet insurance
- Employee resource groups
Waystar is proud to be an equal opportunity workplace. We celebrate, value, and support diversity and inclusion. Qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, national origin, disability status, genetics, marital status, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.
This applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.
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