Senior Operations Associate, Rules Engine

About the Role

Commure seeks a highly skilled and detail-oriented Data Analyst to join our RCM Rules Engine team. This role plays a crucial part in ensuring the accuracy, compliance, and efficiency of billing rules and logic within our Revenue Cycle Management (RCM) system. The Senior Data Analyst will be responsible for conducting thorough quality assurance testing, analyzing large datasets, and working collaboratively with cross-functional teams to refine billing automation processes and improve overall claim acceptance rates. This is an exciting opportunity for a professional with a strong analytical mindset and a passion for improving healthcare operations through data-driven insights.

What You'll Do

1. Conduct comprehensive QA testing on billing rules and logic within the RCM system to ensure compliance, accuracy, and efficiency.

2. Utilize advanced SQL techniques to extract, manipulate, and validate large datasets, ensuring data integrity and accuracy in rule testing and issue resolution.

3. Utilize Python to automate data processing, build models, and perform complex analyses utilizing tools like Retool. Write reusable and efficient code to improve data workflows.

4. Analyze billing transactions, rejections, and denials data to identify patterns, discrepancies, and areas for optimization.

5. Work closely with cross-functional teams to refine and enhance billing automation rules, ensuring alignment with industry best practices and compliance standards.

6. Develop and maintain detailed documentation of test cases, findings, and resolutions to support continuous process improvements and knowledge sharing within the team.

7. Provide actionable insights and recommendations based on data analysis to optimize claim acceptance rates and streamline billing workflows.

8. Proactively identify system inefficiencies and collaborate with stakeholders to implement innovative solutions that drive operational excellence.

What You Have

• Strong proficiency in using SQL, including the ability to write complex queries, perform data validation, and debug issues – Must have.

• Proficiency in Python for data processing and analysis.

• Experience with data cleaning, structuring, and transformation.

• Strong problem-solving and analytical skills, with the ability to make data-driven decisions.

• Exceptional attention to detail and a keen analytical mindset.

• Ability to work with large datasets and handle complex queries.

• Proven ability to manage time effectively and deliver high-quality work within tight deadlines in a fast-paced environment – Must have.

Operational Qualification:

• 1+ years of healthcare billing compliance, regulatory standards, and industry best practices is preferred.

• Ability to collaborate effectively with cross-functional teams and contribute to process improvement.

Soft Skill Requirements:

• Strong written and verbal communication skills with the ability to articulate complex findings clearly.

• Ability to thrive under pressure and efficiently handle multiple priorities.

• High level of attention to detail and commitment to maintaining data accuracy and integrity.

• Adaptability to evolving business needs and a continuous improvement mindset.

• A proactive approach to problem-solving and a strong sense of accountability.

Shift Detail:

• Night shift, 10:00 pm-7:00 am (Monday to Friday)

Commure + Athelas is committed to creating and fostering a diverse team. We are open to all backgrounds and levels of experience, and believe that great people can always find a place. We are committed to providing reasonable accommodations to all applicants throughout the application process.