Real-Time Healthcare Eligibility Analyst (Contract) – Remote

OpenKrill; United States; Remote; USD 117.000 - 124.000; Vollzeit

Zusammenfassung

Chartis is seeking a Real Time Eligibility Analyst for a 3-6 month contract to assess and optimize RTE configurations for high-volume payers. You will develop roadmaps, review plan structures, and ensure accurate coverage and COB workflows.

Must be RTE certified with active RTE experience; Cadence or Prelude certification is a plus. Remote work is allowed, with a focus on sustaining knowledge transfer and clear documentation.

Qualifikationen

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

Aufgaben

• 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.
• 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.

Kenntnisse

RTE Certified

RTE Experience

Cadence

Prelude

Jobbeschreibung

Chartis is seeking a Real Time Eligibility Analyst for a 3-6 month contract to assess and optimize RTE configurations for high-volume payers. You will develop roadmaps, review plan structures, and ensure accurate coverage and COB workflows.

Must be RTE certified with active RTE experience; Cadence or Prelude certification is a plus. Remote work is allowed, with a focus on sustaining knowledge transfer and clear documentation.