Senior Healthcare Economic Consultant - Remote

Primary Responsibilities

• Identify savings initiatives that drive specific and measurable results, providing timely and meaningful client updates
• Participate in analytical, experimental, investigative and other fact-finding work in support of concept development
• Establish solid relationships with internal and external stakeholders to define, align, and deliver payment integrity initiatives in support of assigned clients
• Influence senior leadership to adopt new ideas, approaches, and/or products
• Recommend changes to current product development procedures based on market research and new trends
• Utilize data mining tools (i.e. SQL, Access, Excel) in order to analyze data to support of their hypothesis
• Research policies, coding guidelines, and regulations that would support the hypothesis being developed
• Develop Business Requirement Documentation in a clear, concise, and comprehensive manner
• Clearly communicate concept to business partners/clients and be able to appropriately respond to questions relating to the logic utilized within hypothesis testing, documentation, and the analytic
• Provide mentorship and guidance to Analytic Development Consultants
• Industry thought leader and practice SME

  Required Qualifications

  • BA/BS degree or equivalent experience
  • 3+ years of experience in healthcare (billing, coding, auditing claims)
  • 2+ years of experience conducting analysis on large data sets
  • 1+ years of SQL experience (PLSQL, Teradata, MySQL)
  • 1+ years of experience with claims processing or adjudication systems (Such as UNET, COSMOS, Facets, Diamond, etc. or provider billing / coding knowledge on Professional and Facility claims)
  • Maintains working knowledge of coding standards, billing rules and regulations and knowledge of procedure and diagnosis codes (CPT, ICD10 coding, HCPCS, APC and DRGs)
  • An understanding of healthcare payment methodologies, policies, and coding are necessary
  • Solid computer skills: Access, Excel, Visio, PowerPoint
  • Highly collaborative and consultative style with ability to establish credibility quickly with all levels of management across multiple functional areas
  • Demonstrated solid project management approach with excellent critical thinking and problem-solving skills
  • Demonstrated exceptional presentation, communication and negotiation skills
  • Demonstrated ability to think outside of the box and breakdown complex problems into individual root causes
  • Self-managed, self-starter with the ability to support multiple concurrent projects and meet tight delivery timelines

  Preferred Qualifications

  • Advanced degree in health care or medical field
  • Coding certification through AAPC or AHIMA
  • 5+ years of experience in the health care industry (Medicare, Medicaid, Commercial) with deep exposure to Payment Integrity
  • 2+ years of experience conducting analysis on large data sets
  • 2+ years of experience working in a matrix and highly adaptive environment handling tight deadlines
  • Knowledge of statistical methods used in the evaluation of healthcare claims data
  • Expert SQL coding skills and ability to run test queries to ensure viability of concepts under review