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Must have thorough understanding of ICD-10 Coding; Healthcare Common Procedure Coding System (HCPCS) / Current Procedural Terminology (CPT) coding systems; Medicare Outpatient Prospective Payment System (OPPS), and Ambulatory Payment Classification (APC.
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The ideal candidate is an accomplished subject matter expert who is passionate in making a real impact on preserving the Medicare Trust Fund. He/she should be a confident public speaker with excellent written and oral presentation skills.
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Possesses at least 6+ years recent experience with Medicare and/or Medicaid Part A, B, & DME claims, coding, and reimbursement procedures, service and coverage policies, coordination of benefits, as well as provider and beneficiary eligibility.
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Thorough understanding of claims and healthcare terminology and codes as published by CPT, ICD, HCPCS, and DRG manuals. Understanding of the Centers of Medicare and Medicaid Services (CMS) Integrated Data Repository (IDR.
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Demonstrated performance with high volume data analysis and business intelligence tools such as BusinessObjects, SAS, MicroStrategy, Cognos, etc. Works closely with the team to draft and execute an effective end user support and training strategy.
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Experience with Business Objects for data mining. Conducts data mining, analysis, and reporting using available tools and data sources. Supports local, offsite and online train-the trainer and end-user training classes with subject matter expertise.
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Confident and results-driven self-starter skilled in taking initiative, assessing requirements, coming up with plans, and taking the lead in making plans reality. Experience with statistical data analysis techniques such as modeling, aggregation, trending, patterns, random sampling, and ratios to identify outliers.
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Minimum of a Bachelor's Degree in healthcare or business administration, information technology, public health, or a related discipline, or in another relevant field. Assists in the creation and development of various training materials, including trainer guides, training, video or audio, instructor/participant materials, interactive online courseware, and evaluation systems.
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We deliver creative solutions that exceed goals and foster a dynamic, idea-driven environment that nurtures our employees' professional development. 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.
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Provides on-going healthcare fraud, waste and abuse data, tool and analytics support for users when directed by the team and customer. In this role, the Data Coach will provide subject matter support to the client services team to meet established goals and objectives.
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We thrive off of these fundamental elements that make IntegrityM a great place to work. Supports the help desk in responding to technical and data questions that are received from end users. Ability to meet time-sensitive and mission-critical deadlines with minimal supervision.
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Our small, flexible workplace offers an exceptional quality of life and promotes corporate-driven sustainability. Results are achieved through data analytics, technology solutions, audit, investigation, and medical review.
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Skilled in MS Office 2007 software or higher version: Word, Excel, PowerPoint and Outlook. Stays abreast of industry trends to proactively identify opportunities for fraud or emergent schemes. Ability to review claims for medical necessity, utilization, and level of care to identify aberrant billing practices.
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Able to translate, articulate, simplify and communicate complex business and technical functions to audiences with different level of expertise. Full-time Remote Employee (Temp, potential to turn to Perm.
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Superior communication and organization skills are a must with ability to handle multiple tasks in a fast paced work environment and thrive in an environment with regularly changing priorities. Builds and maintains positive, productive relationships with colleagues, managers, partners, customer, and users to foster collaboration and consensus.
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