Top 21 Claims consultant Jobs in Raleigh, Nc

Business Process Consultant - Revenue Assurance (Remote)
Duke Health —Durham, NC
- Full-time
- Remote
- Microsoft Word
- Writing skills
- Mid-level
Registered Nurse- Regional Minimum Data Set (MDS) Consultant/Clinical Reimbursement Coast
SanStone Health & Rehabilitation —North Carolina
- Full-time
- Nursing
- RN License
- Customer service
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Senior Risk Control Consultant, Field
The Travelers Companies, Inc. —Durham, NC
- $104,000 - $171,700 a year
- Hybrid work
- 7 years
- Driver's License
- Senior level
- Wellness program
- Paid holidays
11d
Litigation Operations Consultant, Projects & Technology – Remote
CSAA Insurance Services, Inc. —Raleigh, NC
- $110,700 - $147,500 a year
- Full-time
- 8 years
- US work authorization
- Senior level
- 401(k) matching
10d
Senior Manager, Business Consulting - Payment Integrity Center of Excellence
CVS Health —Raleigh, NC
- $67,900 - $199,144 a year
- Full-time
- 5 years
- Analysis skills
- Presentation skills
- Health insurance
- Dental insurance
7d
Health Actuary Consultant
Deloitte —Raleigh, NC
- $100,400 - $197,900 a year
- Full-time
- Microsoft Excel
- Up to 50% travel
- Mid-level
13d
Group Employee Benefits Consulting Manager
Accenture —Raleigh, NC
- $87,400 - $293,800 a year
- Full-time
- 3 years
- Bachelor's degree
- Product management
- Paid holidays
- Disability insurance
Information Advisor, Large Pharma
IQVIA —Durham, NC
- $111,200 - $349,000 a year
- Full-time
- Office
- Bachelor's degree
- Doctor of Philosophy
Commercialization Expert
CLEAResult Consulting Inc. —Raleigh, NC
- $120,000 - $140,000 a year
- Full-time
- Remote
- Analysis skills
- Travel
- US work authorization
- Health insurance
- Dental insurance
Quick Apply
Health Actuary Senior Consultant
Deloitte —Raleigh, NC
- $128,000 - $252,500 a year
- Full-time
- Up to 50% travel
- SQL
- Analysis skills
13d
System Integration Engineer - Project Senior Consultant Managed Services
Deloitte —Raleigh, NC
- $91,100 - $143,600 a year
- Full-time
- Computer Science
- System design
- HIPAA
Life Insurance Consulting Manager
Accenture —Raleigh, NC
- $87,400 - $293,800 a year
- Full-time
- 3 years
- Product management
- Travel
- Paid holidays
- Disability insurance
P&C Insurance (Personal & Commercial) Transformation Manager
Accenture —Raleigh, NC
- $87,400 - $293,800 a year
- Full-time
- 5 years
- Analysis skills
- Bachelor's degree
- Paid holidays
- Disability insurance
FP&A Advise Senior Consultant
Deloitte —Raleigh, NC
- $116,200 - $229,100 a year
- Full-time
- CPA
- Up to 50% travel
- Finance
13d
P&C Technical Solutions Architect, Manager
PwC —Raleigh, NC
- $99,000 - $232,000 a year
- Full-time
- Computer science
- 7 years
- Azure
- Paid holidays
- Health insurance
Insurance Technology Strategy Senior Manager
Deloitte —Raleigh, NC
- $175,000 - $322,900 a year
- Full-time
- Computer Science
- Up to 50% travel
- Analysis skills
Commercial Insurance Consultant, Claims Insights- Remote
CSAA Insurance Services, Inc. —Raleigh, NC
- $122,850 - $164,000 a year
- Full-time
- Remote
- Computer Science
- Mid-level
- SQL
- 401(k) matching
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Experienced Managing Consultant Construction Claims and Dispute Resolution
Merge Associates —United States
- $120,000 - $300,000 a year
- Full-time
- Remote
- Background check
- Engineering
- 11+ years
- Health savings account
- Paid holidays
Quick Apply

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Business Process Consultant - Revenue Assurance (Remote)

Duke Health -
Durham, NC

Apply Now

Job Details

Full-time

Qualifications

Statistics
Data visualization software proficiency
Defect resolution root cause analysis
Presentation software
Project management experience in technology
Visio
Business intelligence tools
Bachelor's degree
Project management experience in healthcare
Root cause analysis
Medical claim denial management

Full Job Description

At Duke Health, we're driven by a commitment to compassionate care that changes the lives of patients, their loved ones, and the greater community. No matter where your talents lie, join us and discover how we can advance health together.

About Duke Health's Patient Revenue Management Organization

Pursue your passion for caring with the Patient Revenue Management Organization, which is Duke Health's fully integrated, centralized revenue cycle organization that supports the entire health system in streamlining the revenue cycle. This includes scheduling, registration, coding, billing, and other essential revenue functions.

Duke University Health System - Patient Revenue Management Office (PRMO) seeks to hire a Business Process Consultant who will embrace our mission of Advancing Health Together.

The Business Process Consultant (BPC) serves as the primary analytical resource supporting all revenue cycle processes, systems and workflow. The BPC is a subject matter expert in Epic (Maestro Care), data analytics, payer reimbursement and demonstrates a broad spectrum of operational expertise across many areas of the Revenue Cycle. The BPC supports the Revenue Cycle departments and operational leaders within the Patient Revenue Management Organization (PRMO) by identifying opportunities to improve operational efficiency and performance. The BPC has a system focus through monitoring of dashboards and key metrics to pro-actively identify, analyze, and trend issues. The BPC strategically supports operations by identifying opportunities to improve workflow and effectiveness through projects and innovative solutions to enhance automation, quality and efficiency through enhancement requests, report writing, analysis and business case development and data validation.

Work Performed

Identification and Analysis of Financial Opportunities:

Identify existing and future revenue cycle-based improvement opportunities
Lead PRMO discussions, evaluations, selections and prioritization of improvement opportunities, including the development of an ROI analysis to better understand and determine potential impact on overall PRMO performance
Work closely with PRMO leadership to understand operational goals and challenges to identify opportunities for enhancements
Perform and prepare regular root cause analysis of performance of the revenue cycle function to identify areas of opportunity utilizing various data systems including Slicer Dicer and Tableau
Responsible for various standard, recurring reporting functions to support revenue cycle operational business needs
Assists revenue cycle senior leaders in working closely with organizational stakeholders to improve financial performance based on analytic findings
Monitor key performance indicators for internal and external parties
Cultivates internal relationships to assist in understanding department workflows
Provides analytics for and supports special projects as needed (e.g. new payer policy financial impact)
Support investigation into claims/denials patterns, payer policy changes, collection rate shifts, avoidable write-off’s, and payer mix evaluation to optimize payer performance.

Develop analytical models that are well-documented containing advanced formulas and functions that are used to evaluate historical trends, forecast future expectations, or draw conclusions
Point person for month-end Revenue Cycle Net Revenue Review

Revenue Cycle Strategic Initiatives and Project Management:

Create, design, lead, and implement strategies that will reduce AR, improve aging AR, improve net collection rate, eliminate waste through automation or optimization of workﬂows, reduce denials, and reduce avoidable write -oﬀs, for all areas of the Revenue Cycle
Develop, maintain, and enhance knowledge of Revenue Cycle systems and third-party vendors to support recommendations for optimal workﬂows.
Leverage technology and best practices to recommend process improvements

Collaboration:

Eﬀectively communicate trends to inﬂuence all levels of leadership for process improvements
Partner with leaders and teams to review and establish improvement opportunities
Perform project management duties to align multi-disciplinary groups across the revenue cycle and clinical departments, corporate ﬁnance, DHTS, and hospital service line leadership
Communicate and track progress of identiﬁed issues and action items
Partner with Operations Improvement on outstanding optimization and automation projects

Other:

Promote PRMO strategic vision, mission, and purpose while emphasizing teamwork and results.
Create and foster a department culture that provides a satisfying and enriching environment in which staﬀ can be developed and retained.
Interact with and provide timely verbal/written responses to all stakeholders (patients, providers, payors, and departmental personnel).
Acknowledge management requests and emails in a professional, timely manner.
Attend meetings and participate in Work Culture initiatives, committees or workgroups, as assigned.
Accomplish all tasks as assigned.

Minimum Qualifications

Education

Bachelor's degree required. Master's degree preferred.

Experience

Minimum of 7 years work experience. Extensive knowledge of Revenue Cycle analytical tools, business intelligence tools and statistical packages. Proven experience with Revenue Cycle workflows to include but not limited to overall claims processing spanning the life cycle of the revenue cycle, denials management, insurance follow up, and net collection rate impacts and calculations.

Experience can be supplemented with Master's degree with a Masters being equivalent to two years of experience

Degrees, Licensures, Certifications

None

Knowledge, Skills and Abilities

Knowledge of:

Epic System (Revenue Cycle Applications)
Revenue Cycle operations

Ability to:

Understand revenue cycle operational performance goals/metrics
Strong analytical skills
Perform root cause analysis with accuracy
Identify and implement optimization opportunities within Epic
Investigate and analyze information and provide recommend solutions for identified issues
Develop, implement and oversee project teams comprised of IT and operational resources
Communicate effectively, both orally and in writing
Demonstrate strong interpersonal and communication skills
Work effectively with a wide range of constituencies in a diverse community
Foster a positive work environment
Multi-task

Systems

Epic
MS Office Applications (Word, Excel, Visio, PowerPoint)
Kodiak RCA

Duke is an Equal Opportunity Employer committed to providing employment opportunity without regard to an individual's age, color, disability, gender, gender expression, gender identity, genetic information, national origin, race, religion, sex (including pregnancy and pregnancy related conditions), sexual orientation or military status.

Duke aspires to create a community built on collaboration, innovation, creativity, and belonging. Our collective success depends on the robust exchange of ideas—an exchange that is best when the rich diversity of our perspectives, backgrounds, and experiences flourishes. To achieve this exchange, it is essential that all members of the community feel secure and welcome, that the contributions of all individuals are respected, and that all voices are heard. All members of our community have a responsibility to uphold these values.

Essential Physical Job Functions:

Certain jobs at Duke University and Duke University Health System may include essential job functions that require specific physical and/or mental abilities. Additional information and provision for requests for reasonable accommodation will be provided by each hiring department.

Apply Now

Refine Your Search

claims consultant jobs in raleigh, nc

Business Process Consultant - Revenue Assurance (Remote)

Registered Nurse- Regional Minimum Data Set (MDS) Consultant/Clinical Reimbursement Coast

Senior Risk Control Consultant, Field

Litigation Operations Consultant, Projects & Technology – Remote

Senior Manager, Business Consulting - Payment Integrity Center of Excellence

Health Actuary Consultant

Group Employee Benefits Consulting Manager

Information Advisor, Large Pharma

Commercialization Expert

Health Actuary Senior Consultant

System Integration Engineer - Project Senior Consultant Managed Services

Life Insurance Consulting Manager

P&C Insurance (Personal & Commercial) Transformation Manager

FP&A Advise Senior Consultant

P&C Technical Solutions Architect, Manager

Insurance Technology Strategy Senior Manager

Commercial Insurance Consultant, Claims Insights- Remote

Experienced Managing Consultant Construction Claims and Dispute Resolution

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