[Hiring] Real Time Eligibility Healthcare Analyst @Chartis

Role Description

Real Time Eligibility Analyst (3-6 month contract)

• Must be RTE Certified and have been in active RTE type roles.
• Cadence or Prelude certification a plus.

RTE assessment and prioritization:

• Assess current configuration, errors, workflows, active tickets, and high-volume payers.
• Develop a prioritized roadmap based on volume, impact, urgency, and patient experience.

Payer and plan record strategy:

• Review payer/plan structure, plan mapping, unique plan mapping, synonyms, and ongoing maintenance.

Generic coverage utilization:

• Assess why staff are selecting generic coverages and address the underlying payer/plan configuration, workflow, and education gaps.
• Generic Commercial utilization has already been identified as contributing to claims routing to No Response buckets.

Major payer review:

• Review HB and PB priority payers by 271 section, plan mapping, and benefit filing behavior.

Benefit and service type mapping:

• Review deductibles, copays, Tier 1/Tier 2 benefits, service type mapping, and related estimate accuracy issues.

Coverage creation and automation:

• Optimize RTE coverage auto-creation and Medicare replacement chaining where appropriate.

Coverage Manager and COB:

• Review coverage changes, filing order, COB, and related payer selection workflows.

Registration workflow and education:

• Partner with Patient Access to develop payer selection guidance, Registration education, job aids, and standard workflows that support the configuration changes.

Sustainment:

• Establish monitoring, documentation, ownership, and knowledge transfer so the internal team can maintain the environment.

Tapestry integration:

• Experience is a plus, but not required.

Hourly range: $85-$90. The hourly range for this role takes into account the wide range of factors that are considered in making compensation decisions including, but not limited to, skills, experience, training, licensure and certifications, practice area, and other business and organizational needs.

Qualifications

• RTE Certified.
• Experience in active RTE type roles.
• Cadence or Prelude certification (preferred).

Requirements

• Ability to assess configurations, workflows, and payer interactions.
• Experience in developing roadmaps based on various factors.
• Knowledge of payer/plan structures and maintenance.
• Understanding of generic coverage utilization issues.
• Experience with major payer reviews and benefit mapping.
• Ability to optimize coverage creation and automation processes.
• Experience in developing educational materials and workflows.
• Ability to establish monitoring and documentation processes.

Benefits

• Diverse workforce and equal opportunity employment.
• Celebration of individual uniqueness and perspectives.