Senior PCS Authorization Business Analyst
ABOUT THIS POSITIONThe PCS Business Integration Analyst is the link between Product, Client Success and Development with the goal of providing superior service and support to the various stakeholders responsible for the various Waystar Robotic Process Automation (RPA) product lines.
Utilizing the knowledge of authorizations and referrals, along with rules required by the various health plans, the PCS Business Integration Analyst applies business analysis techniques, tools and common templates to ensure timely and thorough resolutions of all received requests; performs analysis and troubleshooting to identify and correct root causes; and when applicable, delivers business requirements, processes, and/or instructions in a clear and coherent manner to the appropriate stakeholder(s).
The PCS Business Integration Analyst serves as a subject matter expert and helps define and set team strategy to effectively deliver superior service and support up through the department and out to the appropriate stakeholders.
WHAT YOU'LL DO
- Performs business analysis activities, such as requirements analysis, creation of use cases and business rules consistent with workflow requirements of Waystar's Health Systems & Hospital clients.
- Collaborates with Product, Client Success, Technology and/or other departments regarding Robotic Process Automation (RPA), API and EDI related inquiries, activities and business issues.
- Performs data analysis and troubleshooting of application issues and business user concerns to identify and correct root causes.
- Draws on real-world experience and maintains a working knowledge of health plan authorization and referral requirements.
- Applies functional knowledge of ANSI 278, 276/277, 270/271 transaction sets to optimize the design, testing and implementation of defined business requirements associated with RPA, API and EDI based solutions.
- Translates business requirements into detailed requirement specifications and use cases.
- Drives integration through collaboration with various stakeholders in the recommendation, and implementation of enhanced and/or new business processes.
- Acts as liaison between various stakeholders and Development to address questions/issues.
- Must be a self-starter, be able to set priorities and back other team members when required.
- Works team-driven department, cross-department and various sized projects, independent of supervision.
- Executes within defined SLA parameters according to Waystar application and client requirements.
- Serves as a subject matter expert and leverages that knowledge in the decision-making process.
- Helps define and set team strategy to effectively deliver superior service and support up through the department and out to the appropriate stakeholders.
WHAT YOU'LL NEED
- Bachelor’s Degree in Business or related field and/or equivalent relevant work experience.
- 5+ years of business analysis, or Healthcare industry healthcare support/operations experience.
- Experience in medical billing and revenue cycle management. Healthcare Back Office experience in Revenue Coding, Reason/Remark Codes or reconciling pending claims with Payers a plus.
- In-depth knowledge of Prior Authorization or Referrals. Claims Status and Eligibility processing experience a plus.
- Detailed knowledge of ANSI 5010 278, 276/277, 270/271, 837P, and 835, files
- Experience with the prior authorizations and referrals process, along with the benefits verification and insurance rules required by the various health plans.
- Experience navigating commercial insurance portals such as United Healthcare, Availity, and Navinet in the submitting, review and management of prior authorizations and referrals. Experience with RPA (Robotic Process Automation) of these transactions a plus.
- Excellent analytical and problem-solving skills.
- Ability to work well both independently and in a team environment.
- Willingness to learn new skills & tools.
- Excellent communication (written and verbal) and presentation abilities.
- Proficiency in Excel.
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.
- 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.