Commure

Senior Operations Associate, Rules Engine

Commure

full-time

Posted on:

Origin:  • 🇺🇸 United States • California

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Job Level

Senior

Tech Stack

PythonSQL

About the role

  • Conduct comprehensive QA testing on billing rules and logic within the RCM system to ensure compliance, accuracy, and efficiency.
  • Utilize advanced SQL techniques to extract, manipulate, and validate large datasets, ensuring data integrity and accuracy in rule testing and issue resolution.
  • Utilize Python to automate data processing, build models, and perform complex analyses; write reusable and efficient code to improve data workflows.
  • Analyze billing transactions, rejections, and denials data to identify patterns, discrepancies, and areas for optimization.
  • Work closely with cross-functional teams to refine and enhance billing automation rules, ensuring alignment with industry best practices and compliance standards.
  • Develop and maintain detailed documentation of test cases, findings, and resolutions to support continuous process improvements and knowledge sharing within the team.
  • Provide actionable insights and recommendations based on data analysis to optimize claim acceptance rates and streamline billing workflows.
  • Proactively identify system inefficiencies and collaborate with stakeholders to implement innovative solutions that drive operational excellence.
  • Operate on the night shift schedule (10:00 pm-7:00 am, Monday to Friday) as specified.

Requirements

  • Strong proficiency in using SQL, including the ability to write complex queries, perform data validation, and debug issues – Must have.
  • Proficiency in Python for data processing and analysis.
  • Experience with data cleaning, structuring, and transformation.
  • Ability to work with large datasets and handle complex queries.
  • Proven ability to manage time effectively and deliver high-quality work within tight deadlines in a fast-paced environment – Must have.
  • Strong problem-solving and analytical skills, with the ability to make data-driven decisions.
  • Exceptional attention to detail and a keen analytical mindset.
  • Strong written and verbal communication skills with the ability to articulate complex findings clearly.
  • Ability to thrive under pressure and efficiently handle multiple priorities.
  • Adaptability to evolving business needs and a continuous improvement mindset.
  • A proactive approach to problem-solving and a strong sense of accountability.
  • 1+ years of healthcare billing compliance, regulatory standards, and industry best practices (preferred).
  • Willingness to work night shift 10:00 pm-7:00 am (Monday to Friday).
  • Willingness/ability to work onsite in Mountain View, CA headquarters (application asks about working 5 days in HQ).