Healthcare Solution Executive

Healthcare Solution Executive (SME)

Sift is transforming healthcare payments by equipping healthcare organizations to fully leverage their payments data to work smarter, protect their margins and accelerate cash flow. Large health systems, leading HCIT vendors, payers and outsourced revenue management agencies use Sift's Payments Intelligence Platform, ML integrations and advanced analytics to optimize payment outcomes and enable data-driven decision-making within the revenue cycle.

Sift Healthcare is seeking a Healthcare Solution Executive with Mid Revenue Cycle subject matter expertise to join our growing team. For this new position, Sift is looking for an experienced Nurse leader with a technology-led process improvement background in Mid Revenue Cycle (Authorization, Utilization Review (UR) and Clinical Documentation Improvement (CDI), Coding). The Healthcare Solution Executive will work directly with Sift’s health system clients, helping them optimize payer reimbursement using Sift’s revenue cycle software and analytics while adding expertise to Sift’s internal product development initiatives. We are looking for an SME with a serious interest in healthcare IT who will have 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 remote position; however, some travel may be expected.

RESPONSIBILITIES

• Work directly with health system clients to understand their mid revenue cycle challenges
• Provide expert consultation on optimizing payer reimbursement using Sift’s revenue cycle software and analytics
• Conduct detailed assessments and help translate UR, CDI and Coding workflows, user stories, and business requirements into technical specifications
• Tell stories through analyzing data for clinical validation, medical necessity, auth or coding denial patterns; present data to clients and stakeholders and demonstrate how data translates to frontline workflow and key performance indicators
• Provide clinical expertise to guide the design and implementation 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 informational materials and presentations for hospital and health system clients
• Support user guides, training materials and best practice documentation to support client adoption and utilization of the Sift platform
• Prepare and present detailed reports on client performance highlighting areas for enhancement and recommended actions
• Work closely with sales, marketing and client success teams to ensure alignment of clinical expertise with business objectives
• Provide clinical input during sales presentations and demonstrations to prospective clients
• Stay current with industry trends, regulatory changes and best practices in mid revenue cycle management
• Represent Sift at industry conferences, webinars and other events, sharing insights and building the company’s reputation as a thought leader

QUALIFICATIONS

• 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

Compensation will be based on skills, experience, and performance.

ABOUT SIFT HEALTHCARE

Sift is a data science company working to improve payments operations and outcomes in the healthcare industry. We are a growing and dynamic team that is serious about technology. Based in Milwaukee, Wisconsin, Sift is thriving and looking for motivated team members who will help shape our culture. Sift offers competitive salaries and benefits. Learn more about Sift at www.sifthealthcare.com.