Senior Lead Business Analyst at Commence – Virginia Beach, Virginia

The Senior Lead Business Analyst supports the Financial Manager in executing the Federal Independent Dispute Resolution Entity (IDRE) review process. This position works directly with the Response team. Responsibilities include tracking and reconciling communication requests from external parties, involving a thorough investigation of the dispute review and completing a well-written response. Process disputes at the jurisdictional and manual review steps, with full understanding of the complete workflow. The position ensures accurate and timely processing of communication and case reviews and contributes to operational improvements within the IDRE program.

At Commence, we’re the start of a new age of data-centric transformation, elevating health outcomes and powering better, more efficient process to program and patient health. We combine quality data-driven solutions that fuel answers, technology that advances performance, and clinical expertise that builds trust to create a more efficient path to quality care.

With human-centered, healthcare-relevant, and value-based solutions, we create new possibilities with data. We provide proof beyond the concept and performance beyond the scope with a focus on efficiencies that transform the lives of those we serve. With a culture driven by purpose, straightforward communication and clinical domain expertise, Commence cuts straight to better care.

Primary Duties:

• Supports tracking and reconciliation of communication requests from external parties, ensuring timely and accurate processing and monitoring of the ticketing system.
• Determine appropriate responses based on investigation of dispute to formulate an appropriate response.
• Supports tracking and reconciliation of case reviews/disputes, ensuring timely and accurate processing and monitoring of the work queues and correspondence.
• Assists in developing and refining workflows, templates, and documentation tools that support the review process and reporting functions.
• Conducts research to ensure practices are compliant with the Federal IDR process.
• Perform research and analysis for any disputes or discrepancies with parties regarding disputes.
• Audit and review the IDR process to ensure data accuracy.
• Use critical thinking to define problems, identify root causes, and recommend solutions to the quality improvement program through training and education.
• Reconciles and updates portals to ensure accurate entry of dispute information.
• Stay up-to-date on CMS NSA Guidelines and adapt to changes in the No Surprise Act.
• Adhere to all relevant compliance regulations (Health Insurance Portability and Accountability Act, Federal Information Security Management Act, URAC, Centers for Medicare & Medicaid Services, Federal Acquisition Regulation (FAR)).
• Complete other duties as assigned.

Essential Knowledge:

Computer usage is constant and requires knowledge and experience in the application and operation of software programs such as Microsoft Office, all Windows software products, and web-based portals. Work may involve the development of moderately complex spreadsheets, multi-tasking group projects, and assistance with portal development and enhancements. Core competencies include attention to detail, reliability, effective communication, collaboration, accountability, time management, and problem-solving skills.

Essential Education:

• Associate’s degree in healthcare, legal or paralegal studies or business preferred.
• 3-5 years’ experience working with medical billing, claims, appeals, coding, legal, paralegal, customer service, insurance verification, and medical records, with financial and revenue cycle analysis preferred.
• Certifications preferred: Paralegal, Coding

Essential Skills:

• Strong analytical and organizational abilities; skilled at managing multiple tasks while maintaining accuracy
• Effective written and verbal communication; able to convey information clearly and professionally.
• Demonstrated ability to track, analyze, and interpret data.
• Ability to work independently with minimal direction
• Proficient in Microsoft Office Suite, especially Excel (pivot tables, formulas, data analysis), Word, and PowerPoint.

Work Environment/Physical Demands

The work environment and physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

This is an office position. While performing the duties of this job, the employee regularly works in a climate-controlled environment. Candidates must be able to sit, read, work on a computer, and watch a computer screen for extended periods of time. Occasionally required to stand, walk, use hands and fingers, kneel or crouch.

Commence is an equal employment opportunity employer. All personnel processes are merit-based and applied without discrimination on the basis of race, color, religion, sex, sexual orientation, gender identity, marital status, age, disability, national or ethnic origin, military and veteran status or any other characteristic protected by applicable law.

Commence.AI is committed to providing equal employment opportunities to all applicants, including individuals with disabilities. If you require a reasonable accommodation to participate in the application process due to a disability, please contact Human Resources at (757) 306-4920 or hr@commence.ai.

Please note that unless you are requesting an accommodation, all applications must be submitted through our online application system.