Vacancy expired!
- Operational Improvement: For business process that include significant regulatory requirements, you will improve efficiency and business outcomes by leverage process improvement, technology innovation and operating model evolution.
- Clinical Payments Optimization: Assisting clients by validating that payments for clinical healthcare services comply with regulatory and contractual requirements while also determining that payments are appropriate for the type and level of care provided.
- Strategic Risk: Helping clients to embrace their most significant regulatory risks, by enabling senior health care executives to plan for, spot, assess, manage, and respond to those risks to either avoid harm or to embrace risks as opportunity.
- Regulatory Response: Supporting clients with their most pressing regulatory and operational challenges. Helping them to identify, remediate, monitor, and manage enterprise risks and create value through implementing a compliant, resilient enterprise. Includes helping clients manage and respond to internal and external investigations, regulatory concerns and other business controversy.
- BS/BA Degree required in business, finance, accounting or other related subject
- 3+ years of experience working with health plans, healthcare providers, or other healthcare sector companies (e.g. Pharmacy & Life Sciences); or relevant consulting experience
- Experience with healthcare payer or provider operations
- Experience with federal and state regulatory requirements, regulatory compliance, and billing requirements
- Experience with medical related data sets, including medical services documentation and claims data
- Experience designing, implementing and operating risk management and compliance activities
- Experience participating in risk, quality and compliance transformational programs
- Experience leveraging data and analytics to enhance risk management, quality and compliance
- Proficiency in verbal and written communication skills essential to interacting with clients and teams including presentation skills (MS Power Point, MS Visio)
- Practical experience in project management fundamentals, and ability to meet deadlines
- Advanced proficiency with tools like Excel, Access, SQL, and Tableau
- Ability to work independently and manage multiple projects/assignments/responsibilities in a fast-paced environment
- Excellent problem-solving skills with a demonstrated ability to identify issues, resolve them quickly and know when to rely on internal resources to assist
- Ability to travel up to 40%
- Previous consulting experience
- Leading the development of proposals, marketing content, and thought leadership as a key contributor to developing new business
- Master's degree in healthcare administration or related field, preferred
- Any healthcare certification such as RHIA, CMM, AAHAM, CPHRM, CPHIMS, FACHE, preferred
- Experience with application security controls, risk and compliance
- Experience in quality measurement, quality improvement, and value-based payment models
- Proven applicable CPT and ICD-10 coding experience; APR-DRG, MS-DRG and HCC assignment; coding certification and CCDS preferred
- Prior EHR implementation experience including CDM Management, Charge Capture, HIM/Coding, and Clinical Documentation (e.g. Epic, Cerner); other clinical application experience and certifications desired
- Other revenue cycle experience including conducting charge capture and coding reviews for compliance with billing and coding regulatory requirements
- Experience in program and/or project management for technology implementations using third party software
- Knowledge of process excellence (Six Sigma, LEAN, Design Excellence), certifications preferred
- Experience training, educating and coaching
Vacancy expired!