Ability to travel up to 50% of the time. Bachelor's degree. 5+ years combined experience with clinical quality, health care analytics, or driving clinical transformation initiatives with population health programs, Patient Center Medical Homes or in Accountable Care Organizations.
Core Responsibilities Include: Investigating, reviewing, and providing clinical and / or coding expertise in the application of medical and reimbursement policies within the claim adjudication process through file review.
2+ years of experience in provider data analysis. 2+ years experience with claims processing or resolution and medical coding. 1+ years of experience working with reporting tools and generating effective reports. Ability to convey complex information to others and make it more easily understood.
Individual must be able to fulfill the following responsibilities: Performing data quality reviews on inpatient and or outpatient medical records. Ensuring compliance with all APC/DRG mandates and outpatient reporting requirements.
Baseline knowledge and basic familiarity with application of supervised and unsupervised models. Experience in fraud, managed care, insurance, PBM, and/or a healthcare organization analyzing medical and/or pharmacy claims data. Analytical programming tools, specifically SAS and SQL.
A contract research organization has a current position open for a Virtual Senior Medical Writer Phase II through IV in Morrisville. Individual must be able to fulfill the following responsibilities: Providing high-quality medical and scientific writing.
Core Responsibilities Include: Providing standardized training programs for plan staff to improve quality, control medical costs and ensure compliance. Developing and implementing training curriculum for Utilization Management, Case Management, and LTSS staff.
A background in medical billing, running a medical billing company or selling software as a service products. Comfort with All Microsoft Office products, Salesforce. com, and various medical billing software platforms.
Demonstrate and apply keen insight regarding the current Medicare health care regulatory environment and industry competition. Develop and implement a centralized Sales and Marketing strategy. Qualifications Include: 20% travel required. Bachelor’s degree required.
Helping to prepare clients for surveys, conducting medical record analysis, data abstraction and overall data managements. Maintaining the cancer registry database and reporting requirements. Qualifications for this position include: Must have an Active CTR credential.