Job title:Director Payment Integrity Analytics
Job Description:Develop data reporting and client data integrity practices and analytic data architecture. Partner with application developers to ensure optimized data model alignment to support all analytic, product, and service requirements.
Advanced knowledge of database development and data model architecture in SQL
Advanced knowledge of payment integrity data requirements and application of claim adjustment logic to client claims data sets.
Intermediate level of experience with MS Office - Excel, Word, MS PowerPoint, MS Vision
Shows intermediate skills in power BI, Tableau and advanced skills in SharePoint, Microsoft Project Plan (MPP)
Education:- A Bachelor's Degree / MBA or 8 + years of relevant experience in Payment integrity
Experience:- 8+ years' experience in end to end new client implementations on data mining/clinical/coding programs
Mandatory Skills:- Effective handling of highly sensitive, and often highly confidential, information using exemplary judgment, tact and diplomacy
- Exposure to budget, forecast and resource management
- Knowledge of Project management methodologies such as Agile, Waterfall
- Good written/ verbal communication including effective interpersonal skills
- Proven interpersonal skills while contributing to team effort by accomplishing related results as needed
- Must be a team player and adaptable to a dynamic work environment
Preferred Skills:- Intermediate level of experience with MS Office - Excel, Word, MS PowerPoint, MS Visio
- Shows intermediate skills in power BI, Tableau and advanced skills in SharePoint, Microsoft Project Plan (MPP)
Roles & Responsibilities:- This role is to build and implement an effective implementation process and framework for PI audit programs (Datamining and Clinical) and the major functions in the end to end cycle leveraging an integrated PI technology platform to understand the tasks involved related to client implementations.
- One of our key goals of this role is to offer our clients' an excellent on-boarding experience in a timely manner for quick realization of savings
Key Responsibilities:- Should have set up and led high performing teams with cross- functional experience in implementation of end to end Payment Integrity programs in both Pre Pay and Post Pay not limited to Data Mining, DRG, Home Health, SNF, HCD/DME audit types
- Monitor onboarding and off boarding of resources activity including access management
- Support Artifact / Deliverable Management processes, including:
- Monitoring and reporting timely submission of client deliverables
- Collation and initial quality review of deliverables for submission
- Maintain process documents and template updates
- Maintain and configure Project Management tools
- Maintain resource trackers and other forecast information of the project
- Assist project teams with the timely identification, management and resolution of action items, risks, and issues
- Prepare executive status reports with high level of accuracy
- Independently prepare project and program communications
- Participate and prepare materials for meetings
- Monitor Quality Assurance Activities like adherence to compliance items and escalate risks/ issues to team leader
- Review time reports and follow up with any resources to ensure that any missing time is captured and recorded correctly
- Work plan management across multiple projects
- Work on ad-hoc tasks as directed by leadership, in a timely manner with high level of accuracy
- Assists project teams with timely identification, management and resolution of action items, risks, and issues
The above statements are intended to indicate the general nature and level of work being performed by employees within this classification. They are not intended to be an exhaustive list of all responsibilities, duties and skills required of employees assigned to this job. Employees in this job may perform other duties as assigned
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