Category: Curator- Job Hunter

 
 

Description:

Description

SHIFT: Day Job

SCHEDULE: Full-time

 

Your Talent. Our Vision. At Anthem, Inc., it’s a powerful combination, and the foundation upon which we’re creating greater access to care for our members, greater value for our customers, and greater health for our communities. Join us and together we will drive the future of health care.  This is an exceptional opportunity to do innovative work that means more to you and those we serve at one of America’s leading health care companies and a Fortune Top 50 Company.

Our Government Business Division’s Growth Team is looking for a Director of Proposal Strategy to join its Proposal and Capture Group.  Our Director of Proposal Strategy is a People Leader role responsible for leading the strategy, planning, and direction of individual Medicaid proposals, ensuring that the strategy and content identified in our Capture work translate to the proposal in a compliant and compelling way.

[This position can work remotely from any US Anthem location]

Primary duties may include, but are not limited to: Plans, organizes, and manages the work of the Proposal Management unit to support Medicaid, Duals, and specialty products business acquisition in new and existing markets. Oversees all aspects of the proposal development process. Develops bid strategies and strategic positioning of growth opportunities on individual RFPs, RFIs and other sole source opportunities. Conducts in-depth strategic/market research. Provides analytical and strategic development support, including the analysis and synthesis of business, technical, and government documents with a high attention to detail. Works closely with senior management, health plan leaders, and broad cross-functional staff. Serves as primary interface to the Business Owners and Functional Leaders during the proposal development process. Manages contracted/outsourced resources to augment existing staff to respond to proposals. Hires, trains, coaches, counsels, and evaluates performance of direct reports. 

Qualifications

Requires a BA/BS degree in a related field and a minimum of 7 years of related experience including prior leadership experience; or any combination of education and experience, which would provide an equivalent background. 

Highly preferred experience:

 -Experience with Medicaid business development pursuits.

-Experience with large Healthcare backed custom Government proposals. 

-Experience leading the strategy of multiple competing proposal life cycles at once.

-Experience presenting to, liaising with Executives, and cultivating relationships at the Executive level.

-Association of Proposal Management Professional (APMP) membership and certification preferred. 

-MBA or MPH preferred. 

-Ability to travel.

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.


Anthem, Inc. has been named as a Fortune 100 Best Companies to Work For®, is ranked as one of the 2020 World’s Most Admired Companies among health insurers by Fortune magazine, and a 2020 America’s Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.

 
 

Clipped from: https://anthemcareers.ttcportals.com/jobs/7690114-director-of-proposal-strategy-medicaid?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

 
 

 
 

 
 

The Caseworker is that member of patient care operations whose primary function is to assist in providing direct casework services to the patient and family within the hospice program of care.

QUALIFICATIONS

• Qualified candidates will possess a minimum of two (2) years experience in a health-care environment in which the primary job function was community resources utilization which included patient contact.
• Reliable transportation with adequate insurance coverage for driver and passenger or requires ability to cope with the stress of experiencing repeated loss.
• Extensive knowledge of community resources within the specific community in which the hospice is located.
• Knowledge of local, county, applicable state and federal assistance programs.
• Capacity to work with minimal supervision.
• Ability to become proficient in company software programs.

EDUCATION

• Bachelor’s Degree in Social Work or a related Social Science field from an accredited school.

SPECIAL INSTRUCTIONS TO CANDIDATES

• EOE/AA M/F/D/V

 
 

Clipped from: https://getwork.com/details/0e7bff388d1e190a526c394810854298?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Profile

Compliance Director (Medicaid, Healthcare, and Nonprofit Generalist)
Duties: Develop and implement Compliance Program, including a comprehensive Medicaid Compliance Program to prevent fraud, waste, and abuse. Develop and implement risk assessments and an annual compliance workplan, including an annual audit plan. Ensure and strengthen compliance with and understanding of confidentiality and privacy requirements, including HIPAA, 42 CFR Part 2, NYS Shield Law, OMH requirements, and NYC privacy laws. Work closely with the General Counsel, IT, and database staff to identify and address security risks. Develop and implement compliance policies and procedures, including necessary forms to adequately ensure compliance with state and federal laws, regulations, contracts, and best practices. Revise Policies and Procedures as needed to address changes in law. Monitor the organization for potential compliance violations and risk and investigate reports of suspected violations. Conduct audits to assess compliance with critical policies, procedures, and regulations. Design audit tools and audit report formats. Upon identification of non-compliance, provide support to staff by conducting a root cause analysis and corrective action, including training and compliance reviews. Participate in credentialing, fiscal, and other committees and meetings to assess risk and guide compliance activities. Convene and Chair Compliance Committee. Implement and manage procedures for HIPAA Business Associate Agreements and screening for excluded staff and vendors. Identify and implement procedures to strengthen compliance work. Regularly report to the General Counsel, Board of Trustees, and senior staff. Work closely with staff to ensure that compliance is integrated into quality assurance and quality improvement efforts. Participate in organization incident review committees, including conducting investigations. Keep up to date on compliance and regulatory requirements and identify and develop effective compliance tools and resources. Visit all locations and meet with staff on a regularly scheduled as well as spontaneous basis to assess risk, conduct investigations, and educate staff. Conduct education and training including Medicaid training, Code of Conduct, Whistleblower, and other compliance topics. Develop creative compliance education tools and activities such as email blasts, portal and newsletter postings, and Compliance Week activities. Engage in ad hoc tasks at the direction of the General Counsel, including administrative responsibilities.

Qualification and Experience

Qualifications: Master’s degree in Compliance, Healthcare, Business Administration or equivalent education and experience. Law Degree Preferred. CHC or CHPC certification a plus; 10+ years of progressive experience in compliance roles; Prior experience in a Medicaid-funded, healthcare setting required; 5+ years of experience managing projects; Good knowledge of legal requirements, procedures and compliance regulations including HIPAA, 42 CFR part 2, FERPA, Medicaid, OMH regulations, and other applicable regulations; Experience synthesizing laws, regulations, contracts, and working with outside auditors and regulators; Demonstrated ability to identify potential areas of compliance vulnerability and risk and to propose a course of corrective action; Experience developing and implementing audits; Experience developing and conducting trainings; Demonstrated acuity in integrity and professional ethics; Demonstrated problem solving skills; Excellent time management skills and ability to juggle multiple priorities; Excellent oral and written communication skills; and Facile in Microsoft Excel, SharePoint, and other programs to facilitate program management and compliance.

Additional info

Send updated resume with a cover letter. No phones calls, please.

Company info

Hiring Coordinator
CASES, Inc
151 Lawrence Street, 3rd Floor
Brooklyn, NY 11201

 
 

Clipped from: https://www.lawcrossing.com/job/id-92936ee779c106c0632d302457d432e6?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

 
 

 
 

Description

SHIFT: Day Job


SCHEDULE: Full-time

Your Talent. Our Vision. At Anthem, Inc., it’s a powerful combination, and the foundation upon which we’re creating greater access to care for our members, greater value for our customers, and greater health for our communities. Join us and together we will drive the future of health care. This is an exceptional opportunity to do innovative work that means more to you and those we serve at one of America’s leading health care companies and a Fortune Top 50 Company.

Our Government Business Division’s Growth Team is looking for a Business Development Capture Director – Medicaid to join its Business Development and Capture Group. Our Business Development Capture Director is a high-performing individual contributor role responsible for positioning and capture execution of Medicaid health plan procurement and reprocurement opportunities. He/she is responsible for managing the strategy and preparations for upcoming Medicaid RFPs. He/she partners with Plan Presidents to lead the cross functional team of health plan leaders and business development to identify gaps, mitigate risks, and develop solutions and strategy in months prior to an RFP.

[This position can work remotely from any US Anthem location]

Primary duties may include, but are not limited to: Monitor and evaluate white space opportunities to make go/no-go recommendations to executive leadership. Develop and execute plans for the pursuit and capture of all Medicaid managed care procurement opportunities, including Alliance partnership opportunities. Leads the cross functional team of Growth Partners, Health Plan leaders, and Alliance partners (as applicable) to develop winning strategies and identify and mitigate risks and opportunities. Participates in bid decisions and develops recommendations for gate reviews. Collaborates with Health Plan Presidents and Health Plan leaders to understand current and emerging customer needs and requirements. Obtains market intelligence and competitive data to develop market strategy. Participates in all levels of proposal development and draft review, providing active feedback and recommendations for improvement. Provides mentorship and coaching to other members of the broader Business Development team.

Qualifications

Requires a BA/BS degree in a related field; 10 years of leadership/management experience in health care management, marketing products, and managing significant business results; or any combination of education and experience, which would provide an equivalent background.

Highly preferred experience:

• Previous P&L and/or business development experience and project management experience in Medicaid managed care setting.

 
 

• Experience leading capture and proposal activities for significant opportunities ($1B and more) strongly preferred.

 
 

• Experience in a capture function or executive leadership function for a managed care based product for state Medicaid agencies.

 
 

• State Medicaid agency experience or federal agency experience with CMS.

 
 

• MBA preferred.

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.


Anthem, Inc. has been named as a Fortune 100 Best Companies to Work For®, is ranked as one of the 2020 World’s Most Admired Companies among health insurers by Fortune magazine, and a 2020 America’s Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.

 
 

Clipped from: https://www.glassdoor.com/job-listing/business-development-capture-director-medicaid-anthem-JV_IC1145013_KO0,46_KE47,53.htm?jl=1007344605205&utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Location: Remote

Categories: Transaction Processing

Req ID: 2021-45565

Job Description

About Conduent

Through our dedicated associates, Conduent delivers mission-critical services and solutions on behalf of Fortune 100 companies and over 500 governments – creating exceptional outcomes for our clients and the millions of people who count on them.

You have an opportunity to personally thrive, make a difference and be part of a culture where individuality is noticed and valued every day.

Job Description

Job Track Description:

• Performs tasks based on established procedures.
• Uses data organizing and coordination skills to perform business support or technical work.
• Requires vocational training, certifications, licensures, or equivalent experience.

General Profile

• Has a developed proficiency of analytical or operational processes.
• Completes atypical assignments.
• Works within established procedures and practices.
• May establish the appropriate approach for new assignments.
• Acts as a resource for colleagues.
• Completes work with limited supervision.

Functional Knowledge

• Has developed skills in a range of processes, procedures, and systems.

Business Expertise

• Understanding of how best teams integrate and work together to achieve company goals.

Impact

• Impacts a team, by example, through the quality service and information provided
• Uses discretion to change work procedures and practices.

Leadership

• May provide guidance and support to junior team members.

Problem Solving

• Provides solutions to atypical problems based on existing precedents or procedures.

Interpersonal Skills

• Exchanges information and ideas effectively.

Responsibility Statements

• Conducts medical and pharmacy benefit insurance verifications and investigations for commercial and government payers.
• Interprets patient insurance, prescription, and other health-related documentation.
• Researches available alternative funding options to reduce patient’s financial responsibility.
• Applies prescription drug benefit management techniques.
• Examines records to transcribe medical codes.
• Validates licensed practitioners.
• Performs other duties as assigned.
• Complies with all policies and standards.

Closing

Conduent is an Equal Opportunity Employer and considers applicants for all positions without regard to race, color, creed, religion, ancestry, national origin, age, gender identity, gender expression, sex/gender, marital status, sexual orientation, physical or mental disability, medical condition, use of a guide dog or service animal, military/veteran status, citizenship status, basis of genetic information, or any other group protected by law.

People with disabilities who need a reasonable accommodation to apply for or compete for employment with Conduent may request such accommodation(s) by clicking on the following link, completing the accommodation request form, and submitting the request by using the “Submit” button at the bottom of the form. For those using Google Chrome or Mozilla Firefox please download the form first: click here to access or download the form. You may also click here to access Conduent’s ADAAA Accommodation Policy.

Clipped from: https://jobs.conduent.com/job/13531900/medical-claims-associate-medical-medicaid-remote/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

 
 

Description

Humana is an $80 billion (Fortune 41) market leader in integrated healthcare with a clearly defined purpose to help people achieve lifelong well-being. As a company focused on the health and well-being of the people we serve, Humana is committed to advancing the employment experience and vitality of the associate community. Through offerings anchored in a whole-person view of human well-being, Humana embraces a focus on stimulating positive individual and population changes while nurturing a sense of security, enabling people to live life fully and be their most productive.

Against that backdrop, we are seeking a talented professional to join our team as Director, State Public Policy. This role resides within the Corporate Affairs Department and will serve as an expert in state public payer, Medicaid and Duals public policy while working with subject matter experts and business units within the Humana enterprise including our Retail, Provider, Healthcare Services, and Humana Pharmacy Solutions (HPS) business units.

You will be an instrumental part of Corporate Affairs at Humana by assisting in the development of Humana’s public policy positions for our public payer businesses with an emphasis on Medicaid, Medicare Supplement, state retiree, Duals policy, and future state public health programs. This will require you to engage across the company to analyze public policy, develop positions, and draft deliverables supporting Humana business strategy.

We are open as to where this position can be located, but cities in Kentucky, Florida, Illinois, Ohio, Texas, Wisconsin, or Washington D.C. would be ideal.

Responsibilities

• Under direction of the Vice President of Strategy and State Affairs, and with input from enterprise subject matter experts, analyze, draft, and develop state public payer policy positions to support the enterprise’s priorities.
• Performs necessary research and analyses to support enterprise positions and priorities.
• Provides regulatory guidance, general issue management and strategic stakeholder engagement support to Corporate Affairs and business leaders.
• Develops and maintains an archive of legislative and regulatory analyses, policy briefs, reports, position statements, and other materials pertinent to Humana’s public payer policy and advocacy work.
• Works closely with Humana Medicare, Medicaid and other lines of business to develop value propositions, white papers and other advocacy materials which support state business development opportunities.
• Drafts and communicates concise and clear descriptions/analyses/summaries of key issues to Corporate Affairs and Humana businesses.
• Monitors state Medicaid trends. Contributes policy expertise to state-level advocacy efforts on public payer issues including Medicaid expansion, an extension of Medicaid managed care to new populations and programs, integration of the Duals population and state initiatives that affect the role of managed care in Medicaid programs.
• Acts as an interface between Humana and national advocacy, trade associations, and public policy organizations; assists in the management of policy consultants; develops external stakeholder outreach strategies.
• Maintains current awareness and analyzes/compares trends, positions, and issues promoted by other companies, trade, and advocacy organizations active on Medicaid-related issues.
• Assists in the preparation and drafting of testimony, regulatory comments, and position statements sent to legislative and regulatory bodies and other interested parties concerning legislation, policies, published reports, regulations, and statutes governing Medicaid, long-term services and supports (LTSS), and other waiver programs.

Key Candidate Qualifications

The successful candidate will have extensive experience (typically 8+ years) in health policy – preferably as a Medicaid, State legislative or executive branch staffer or equivalent experience in Medicaid policy, trade group, law firm, or policy organization. This person will also have strong knowledge of state health administrative/regulatory/licensure rules and guidance as well as state health policy. Key to success will be a proven track record of applied analysis, research, and resource development supporting healthcare policy, and translating information from diverse resources into actionable policy documents for use in an advocacy setting or otherwise. A Bachelor’s degree is required, preferably in health/public policy, economics or health care administration, although a Master’s degree will be a strong plus.

In addition to the above, the following professional qualifications and personal attributes are also sought:

• Prefer demonstrated, strong relationships with policy makers and thought leaders in the state public policy arena.
• Ability to work in cross-functional teams (matrix environment) including interfacing with business executives to develop and align policy/advocacy positioning with strategic business goals.
• Prefer an academic background in policy, public affairs, business, or a clinical profession.
• Solid understanding of relevant policy and regulatory issues and ability to translate complex issues in clear, concise manner to business leaders and advocacy team (technical and non-technical audiences)
• A passion for the development of innovative, high quality government healthcare programs
• Experience working in a matrixed organization, with proven ability to work collaboratively through various departments and functional areas, promoting a culture of proactive teamwork.
• Strong conceptual and creative thinker with an ability to identify trends and interrelationships
• Excellent oral and written communications skills, including the polish, poise, and executive presence that will ensure effective interaction with senior and executive level audiences internally and externally.
• Strong creative problem-solving, negotiation, and multi-tasking skills in time-sensitive settings.
• Highly-developed interpersonal skills with ability to build strong working relationships, internally and externally.
• Ability to meet clearly stated expectations and take responsibility for achieving results
• We will require full COVID vaccination for this job as we are a healthcare company committed to putting health and safety first for our members, patients, associates and the communities we serve.
• If progressed to offer, you will be required to provide proof of full vaccination or documentation for a medical or religious exemption consideration where allowed by law. Requests for these exemptions should be submitted at least 2 week prior to your scheduled first day of work.

Scheduled Weekly Hours

40

Clipped from: https://getwork.com/details/23f3bfc298c49a71456bfbf7d580ae9e?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Description

Humana’s Enterprise Shared Services (ESS) organization is looking for an experienced Implementation & Integration Advisor (internally known as an Acquisition Integration Advisor) to join the Business Management team working from home anywhere in the US. The Business Management team leads and operationalizes large-scale, cross functional initiatives to successful and timely outcomes. As part of this team you will perform project/program oriented duties related to the integration of acquired entities into the company as well as support new State Medicaid Implementations.

Responsibilities

As the Implementation & Integration Advisor you will provide expertise in executing implementations that focus on:

* Managing and executing implementations (including Medicaid & Medicare) from end to end, including developing structure and strategies, managing timelines, reducing risks, ensuring for successful implementations

* Helping deliver cross-functional, enterprise projects executed in partnership with corporate development opportunities and senior leadership

* Being responsible for a detailed understanding of the business being acquired or implemented

* Leveraging Best Practices and developing repeatable and scalable technical and business processes

* Working with leadership to promote stakeholder awareness via formal engagement management and communication processes

* Developing and managing implementation/integration plans to support business thru run-out and/or sun-setting of systems as required

Based on current guidance from the CDC, local and state governments, and Humana leadership related to the coronavirus (COVID-19) outbreak have extended travel restrictions until further notice. The policy will be reassessed as the situation warrants. Once these restrictions are lifted this role may require up to 15% travel depending on business needs.

Required Qualifications

* Bachelor’s degree or equivalent related work experience
* 8+ years of operations, project/program management, implementation and/or consulting, corporate strategy, acquisition experience – and ability to “flex” between what is necessary for each project
* 3+ years’ experience leading large scale, highly visible enterprise programs with responsibility for cross functional work streams/project teams
* Strategic thinker – proven ability to apply foundational strategy principles to a variety of business problems
* Excellent organizational, written and oral communication and presentation skills
* Exceptional interpersonal skills with ability to quickly build rapport. Strong collaboration and facilitation skills
* Ability to influence at all levels of the organization
* Proven experience interacting directly with and presenting to Senior Leadership internally and externally
* Advanced proficiency in MS Office applications including Project, PowerPoint, Visio, SharePoint and Excel
* Strong business acumen with ability to interrupt analytics
* Must be passionate about contributing to an organization focused on continuously improving consumer experiences
* Ability to travel up to 15%

Work at Home/Remote Requirements

* Must ensure designated work area is free from distractions during work hours and virtual meetings
* Must provide a high-speed DSL or cable modem for a workspace (Satellite and Hotspots are prohibited). A minimum standard speed of 10×1 (10mbs download x 1mbs upload) for optimal performance of is required

Preferred Qualifications

* Possess solid understanding of how organization capabilities interrelate across operational work streams
* PMP certification
* Advanced degree

Scheduled Weekly Hours

40

 
 

Clipped from: https://tarta.ai/j/_eiGSHwBPV406l6XjZmg-medicare-medicaid-implementation-amp-integration-advisor-remote-us-in-birmingham-alabama-at-humana-inc?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Resp & Qualifications


PURPOSE:


The Controller is to manage and deliver timely accurate and informative financial data and analysis, ensure internal compliance and safeguards of corporate assets and issue and enforce appropriate policy.


Essential Functions

• Reviews monthly financial statements, questions and reviews all financial data submitted, holds business reviews, and communicates and provides guidance to the business.
• Provides data and financial analysis in support of external customer requirements, Group/Corporate data calls and audit requests. Evaluates financial plans by identifying financial outcomes and potential returns.
• Delivers reliable and precise execution of day-to-day Business Operations responsibilities including cost accounting, revenue recognition, subcontractor financial management, At Risk coordination, forecasting and EAC development, variance analysis, and cash flow management (to include timely unbilled analysis/reconciliations).
• Collaborates with Corporate Compliance to support all Medicaid audits, reviews and examinations conducted by internal audit staff. Directs and oversees internal Medicaid risk assessments, to ensure that appropriate staff are fully aware of objectives and that they can produce and maintain suitable records, reports, and files which adequately document planning, execution, and reporting for all relevant activities pertaining to the regulations, including documentation and storage of policies and procedures. Develops and implements internal compliance monitoring procedures. Ensures conclusions, findings and recommendations for improvement or corrective action are appropriately presented to management staff for review, and verify that all findings are accurate, complete and objective.
• Maintain and improve a system of internal controls to safeguard company assets and reduce the risks of fraud and misstatement of financial records.
  
  

Qualifications


Education Level: Bachelor’s Degree in Accounting, Finance, Business, or related field. In lieu of a Bachelor’s degree, an additional 4 years of relevant work experience is required in addition to the required work experience.


Experience: 10 years progressive experience in an analytical role within a financial services or professional services company


Preferred Qualifications: MBA, CPA


Additional Knowledge/Skills


Experience in working with and/or knowledge and understanding of one or more of these financial and accounting topics are desired:

• Accounting, including Statutory Accounting for Insurance Companies and related Quarterly and Annual Statement filings
• Financial Reporting requirements of MD and DC Medicaid
• Medicare Part D and related settlement
• Risk Score for both Medicare and Medicaid
• Rate Setting processes for Medicaid
• CMS Bid Development for Medicare
• CMS Payment Methodology and Data Structure – MMR, PPR, etc.
• Risk Based Capital
• Financial and Regulatory Audits
  
  

Department


Department: MD Medicaid – Finance


Equal Employment Opportunity


CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.


Hire Range Disclaimer


Actual salary will be based on relevant job experience and work history.


Where To Apply


Please visit our website to apply: www.carefirst.com/careers

Closing Date


Please apply before: 10/29/21


Federal Disc/Physical Demand


Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.


Physical Demands


The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted.


Sponsorship in US


Must be eligible to work in the U.S. without Sponsorship

 
 

Clipped from: https://www.linkedin.com/jobs/view/controller-md-medicaid-at-carefirst-bluecross-blueshield-2735164919/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

 
 

 
 

Integrity Management Services, Inc. (IntegrityM) is an award-winning, women-owned small business specializing in assisting government and commercial clients in compliance and program integrity efforts, including the prevention and detection of fraud, waste and abuse in government programs. Results are achieved through data analytics, technology solutions, audit, investigation, and medical review.


At IntegrityM, we offer a culture of opportunity, recognition, collaboration, and supporting our community. We thrive off of these fundamental elements that make IntegrityM a great place to work. Our small, flexible workplace offers an exceptional quality of life and promotes corporate-driven sustainability. We deliver creative solutions that exceed goals and foster a dynamic, idea-driven environment that nurtures our employees’ professional development. Large company perks…Small company feel!


http //www.integritym.com


We are now seeking a Sr. Healthcare Fraud Data Analyst to join our team.


Position Description


The essential functions of this position include

• Participate and coordinate the identification, documentation, analysis and validation of advanced business processes, systems, and solution requirements.
• Researches, evaluates and designs components of complex solutions to problems.
• Provides expertise to support requirements of cross-functional initiatives and projects, while contributing to the development and techniques used to meet the requirements of the business unit.
• Ensures customer satisfaction by handling unique and difficult situations/projects under minimal direction in a timely and quality manner.
• Ability to resolve/recommend action on most issues.
• Handle escalated issues from customers with minimal assistance.
• Manage multiple assignments with little to no supervision.
  
  

Requirements


Qualifications

Qualified candidates will possess the following

• Bachelor’s degree or equivalent work experience in health care fraud, waste and abuse. May hold advanced certification in work field.
• 3-5 years of work experience in the healthcare fraud environment.
• Expert knowledge of commercial and government insurance programs.
• At least 3 years’ experience in Medicare, Medicaid or both.
• Expert level of understanding and application of healthcare related technologies.
• Extensive knowledge and experience with project management, research and problem resolution techniques.
• Ability to plan, develop and manage the scope of a complex project/issue with minimal direction from leadership.
• Three or more years’ experience developing proactive data projects from conception to identification of investigative leads.
• Strong proven analytical ability and basic knowledge of statistics and sampling techniques.
• Strong computer skills including Microsoft Access, experience in relational data base design, extract and reporting, Excel and the Internet.
• Proven ability to work with a variety of systems, sources of data and analytic tools.
• Three or more years’ experience in CMS systems such as OnePI, SAS, EBI, Business Objects and (preferably) the Unified Case Management tool.
• Strong communication and organization skills.
  
  

All candidates MUST pass a background check and drug screening prior to employment.


Integrity Management Services, Inc. does not discriminate on the basis of race, sex, color, religion, age, national origin, marital status, disability, veteran status, genetic information, sexual orientation, gender identity or any other reason prohibited by law in provision of employment opportunities and benefits.


Benefits


Salary

Commensurate with experience.

 
 

Clipped from: https://www.linkedin.com/jobs/view/sr-healthcare-fraud-data-analyst-medicare-medicaid-at-integrity-management-services-inc-2738863045/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

 
 

 
 

Geebo » Austin, TX » Employment » Other

[Close]