Sift Healthcare is seeking a Mid Revenue Cycle SME to join our growing team.
Sift is transforming healthcare payments by equipping healthcare organizations to fully leverage their payments data to work smarter, protect their margins and accelerate cash. Large health systems, leading HCIT vendors, payers and outsourced revenue management agencies use Sift's Payments Intelligence Platform, ML integrations, advanced analytics and reporting to optimize payment outcomes and enable data-driven decision-making within the revenue cycle.
For this new position, Sift is looking for an experienced Nurse leader with a technology-led process improvement background in Mid Revenue Cycle (Auth, Utilization Review (UR) and Clinical Documentation Improvement (CDI)). The Mid Revenue Cycle SME will work directly with Sift’s health system clients, helping them optimize payer reimbursement using Sift’s revenue cycle software and analytics while also adding expertise to Sift’s internal product development initiatives.
We are looking for an SME who has a serious interest in clinical informatics or healthcare IT and the opportunity to use that subject matter knowledge to enhance Sift’s technology solutions focused on reducing concurrent and back-end denials related to CDI or UR workflows.
This is a full-time position. However, we will consider part-time candidates passionate about creating better solutions. The candidate will be able to work remotely; however, some travel may be expected.
▹ Effectively communicate and help translate CDI and UR workflows, user stories, and business requirements into technical specifications
▹ Data resourcefulness - storytelling through analyzing data for clinical validation, medical necessity, auth or coding denial patterns
▹ Create and/or validate functional requirements, user testing and operational/financial outcome measurement methodologies
▹ Connect experiences with the opportunities that process improvement can have for specific job functions at hospitals or at large Payer organizations (improvement opportunities included but not limited to ML and standard operating procedure changes to execute technology change)
▹ Create information materials and presentations for hospital and health system clients
▹ Present denials data to clients and stakeholders and demonstrate how data translates to frontline workflow and key performance indicators
▹ Registered Nurse with an active license in good standing
▹ Prior experience with hospital medical necessity and clinical validation denials (5+ years of experience is preferred)
▹ UR and/or CDI experience in a hospital setting
▹ Knowledge of government and managed care contract reimbursement requirements
▹ Prior experience with data analytics and presenting in front of various stakeholders
▹ Excellent verbal and written communication skills
▹ Leadership and/pr project management experience
▹ ACM or CCM certification (UM/CM focus) is preferred
▹ CCDS or CDIP certification (CDI focus) is preferred
Compensation will be based on skills, experience and performance.
Sift is a data science company, working to improve payments processes in the healthcare industry. We are a growing and dynamic team that is serious about technology. Located in Milwaukee, Sift is thriving and looking for motivated team members who will help shape our culture. Sift offers competitive salaries and benefits.