Role Overview
This role recognizes and reports new concepts for development with minimum assistance. The incumbent might be tasked to multiple clients and/or programs. They also understand the data mining process and will occasionally be tasked with training and assistance on process improvements.
What You Will Do
Researches new concepts for development to determine applicability to client requirements. Utilizes department tools to research concepts, including client claims processing policies, CMS/OIG/RAC public information, and provider/member contracts. Documents new concepts in an appropriate format and partners with Microsoft SQL developers to develop efficient output of concepts.
Why It Might Be a Fit
This role is suitable for individuals with experience analyzing medical claims paid/processed data, working across multiple clients with varying claims processing policies, and utilizing tools to identify new concepts on data. The ideal candidate will have strong attention to detail, problem-solving abilities, and excellent written communication skills.
Requirements
- Minimum high school diploma and two (2) years' experience analyzing medical claims paid/processed data
- Bachelor’s degree in a relevant field of study is strongly preferred
- Experience on multiple claims processing platforms
- Experience working across multiple clients with varying claims processing policies
- Experience with various types of medical healthcare claims, including inpatient, outpatient, professional, and experience with various types of medical healthcare payment methods, including DRG, Per Diem, Outpatient Surgery Groupers, RUG, OASIS, Fee Schedule
- Required licensures, professional certifications, and/or board certifications as applicable
- Ability to recognize new concepts that lead to overpayments
- Ability to work efficiently across multiple clients
- Experience utilizing tools to identify new concepts on data (ReThink Analyzer)
- Strong attention to detail and proven problem-solving abilities
- Excellent written communication skills
- Effective time management skills
- Flexibility during times of change
- Highly self-motivated
- Ability to quickly apply new technologies/techniques and adapt to shifting priorities and timelines
Benefits
- Medical, dental and vision coverage with low deductible & copay
- Life insurance
- Short and long-term disability
- Paid Parental Leave
- 401(k) + match
- Employee Stock Purchase Plan
- Generous Paid Time Off – accrued based on years of service
- 10 paid company holidays
- Tuition reimbursement
- Flexible Spending Account
- Employee Assistance Program
- Sick time benefits – for eligible employees, one hour of sick time for every 30 hours worked, up to a maximum accrual of 40 hours per calendar year, unless otherwise required by state law
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