Business Consultant

HealthEdge

Business Consultant overseeing Tier 1 and 2 consulting initiatives for healthcare operations. Providing subject matter expertise and mentoring to service delivery teams.

Posted 6/29/2026full-timeRemote • 🇺🇸 United StatesMid-LevelSenior💰 $90,000 - $120,000 per yearWebsite

About the role

Key responsibilities & impact

The Business Consultant leads and mentors the Service Delivery team in all Tier 1 (Basic) and Tier 2 (Intermediate) consulting initiatives
The position provides in-depth and comprehensive subject matter expertise related to Burgess products (from basic to advanced features/functionality), payment methodologies/policies (Medicare, Medicaid, and commercial), payment integrity, and healthcare plan operations (e.g., claim life cycle/workflow, network contracting, payment/policy configuration, provider relations, medical management, medical economics, audit, compliance) related to implementation/consulting engagements, strategic user adoption initiatives, and ongoing client support.
Provide the highest level of product education (from basic to advanced features/functionality to Burgess end-users
Provide in-depth and comprehensive subject matter expertise related to: Medicare, Medicaid, and commercial payment methodologies/policies
Payment integrity
Healthcare plan operations (e.g., claim adjudication life cycle/workflows, network contracting, payment/policy related configuration, provider relations, medical management, medical economics, audit, compliance)
Conduct collaborative scoping sessions to identify client needs and appropriate solutions
Actively manage and/or participate in the development, maintenance, and execution of client facing education services
Manage issues, questions, inquiries of Tier 1 and 2 escalation
Serve as escalation point for critical client needs as warranted
Lead diagnosis and resolution of escalated and more involved/complex client problems and issues
Act as a liaison between clients and internal support staff (research, development, and product teams) to assure accurate problem interpretation and resolution
Capture and solicit issues/feedback from clients and internal stakeholders and document issues and client impacts.
Partner with appropriate Burgess Teams (BA, PM, Development, Account Management, Sales/Business Development, Product, Content, and Service Delivery) to manage problem framing, diagnosis and resolution
Conduct/ participate in root cause analysis to identify and deliver warranted service improvements
Maintain communication with customers during the problem resolution process, utilizing superior customer service skills
Mentor and provide oversight for Tier 1 and 2 Service Delivery staff
Take direction from and collaborate with Service Delivery Leadership to continually review and enhance performance and strategy.

Requirements

What you’ll need

Bachelor’s degree in a business, health services administration, mathematics, science or related field, and/or equivalent work experience required
AHIP, HFMA, AAPC, and/or AHIMA certification preferred
5+ years training, education, and/or consulting experience preferred
Practical understanding of the healthcare system with regards to Medicare, Medicaid, managed care, and commercial payment methodologies, payment integrity, and health plan operations (e.g., claim life cycle/workflows, network contracting, payment/policy related configuration, provider relations, medical management, medical economics, audit, compliance)
Experience with interpretation/translation of complex health-plan in-network and out-of-network provider rate and/or claim editing provisions
Experience with configuration and maintenance of provider rate and/or claim editing provisions in a claims adjudication system and/or third-party vendor application
Working knowledge of claim billing specifications (e.g., CMS-1500, UB-04, 837, HIPAA code sets)
Creative problem-solving skills including the ability to identify, recommend, and implement strategic solutions
Ability to manage issues, requests, problems, and situations of all Tier 1 and 2 escalation levels
Demonstrated ability to conduct education/training sessions to large audiences across multiple skill levels
Strong analytical skills
Excellent organizational skills
Excellent communication (both written and verbal) and interpersonal skills
Ability to learn and adapt to new technologies and systems
Ability to adapt to a changing and rapidly growing environment
Effectively manage multiple priorities and follow through on all projects to completion.

Benefits

Comp & perks

Health insurance
401(k) matching
Flexible work hours
Paid time off
Remote work options

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

Claims AdjudicationPayment IntegrityProvider RelationsMedical ManagementAudit ComplianceConfiguration of Claims SystemsClaim Billing SpecificationsRoot Cause AnalysisStrategic Solution ImplementationData Analysis

Soft Skills

Creative Problem-SolvingExcellent CommunicationOrganizational SkillsInterpersonal SkillsAdaptability

Certifications

AHIP CertificationHFMA CertificationAAPC CertificationAHIMA Certification