Business Process Specialist

Join a mission-driven healthcare organization dedicated to improving access and quality of care for diverse communities. This role plays a critical part in supporting system transformation initiatives and enhancing provider network operations.

Responsibilities:

• Support migration to a new core claims system (Health Rules Payer - HRP) for Provider Network Operations
• Participate in project meetings across all phases including preparation, testing, and post-go-live activities
• Maintain issue tracking logs and support resolution of provider-related system issues
• Assist in updating process documentation, policies, and procedures
• Prepare executive summaries and communication materials regarding system updates
• Represent leadership in operational and project meetings as needed
• Support provider data quality assurance across multiple platforms including CACTUS, PowerStepp, HRP, and Salesforce
• Monitor and triage provider complaints related to system migration
• Perform data collection, extraction, analysis, and reporting related to migration efforts
• Act as liaison between Credentialing, Provider Maintenance, and Customer Service teams
• Assist with additional projects and operational initiatives as assigned

Qualifications:

• Bachelor’s degree or equivalent combination of education and experience
• 3 to 5 years of experience within a health plan environment; Medicaid experience preferred
• Understanding of provider network management and healthcare system structures
• Familiarity with provider contracts, Medicare fee schedules, and CPT/HCPCS coding
• General knowledge of claims adjudication processes; Health Edge/HRP experience preferred
• Experience with Salesforce; healthcare setting preferred
• Strong analytical, organizational, and problem-solving skills
• Ability to manage workload independently and meet deadlines in a fast-paced environment
• Proficiency in Microsoft Office Suite including Excel, PowerPoint, and SharePoint
• Strong communication skills with the ability to present findings and recommendations

"Please note that the salary range and/or hourly rate range of $60.00 - 70.00 is a good faith determination of potential base compensation offered to applicants at the time of this job advertisement and may be subject to modification in the future. When determining a team member's base salary and/or hourly rate, various factors may be taken into account as applicable (such as location, specialty, service line, years of relevant experience, education, credentials, negotiated contracts, budget, and internal equity).

For consideration to this and/or other roles suitable for your background, please submit your most up-to-date resume to join our talent pool.

At ATRIA Consulting, LLC, we are a woman-owned business fully committed to promoting, cultivating, and maintaining a culture of diversity, equity, and inclusion. We embrace and celebrate differences across all demographics and backgrounds. We encourage everyone to apply.