reputed company Inpatient Data Analyst (Part-time, Remote)

30 hours per week In this role, the reputed company Inpatient Data Analyst will provide subject matter expertise in support of analyzing Medicare inpatient claims data to reputed company comparative billing reports and programs to evaluate payment patterns electronic reports. The reputed company Inpatient Data Analyst will also have to conduct research of report and reputed company development in support of Medicare fee-for-service claims data analysis. The reputed company Inpatient Data Analyst may coordinate with CMS and other stakeholders for report support and education. Job Responsibilities:

• Assist in the development of comparative billing reports (CBR) and programs to evaluate payment patterns electronic reports (PEPPER) reports in support of CMS’s effort to reduce Medicare fee-for-service improper payments.
• Uses data science techniques to reputed company and review tasks such as:
• Data Analysis on large data sets
• Data Mining
• Statistical Analysis, and
• Text Mining
• Participate in the evaluation of reputed company areas for reputed company PEPPER types, providing recommendations for discontinuation or identifying new reputed company areas that could benefit specific facility types.
• Conduct claims data analysis to assist in the development of PEPPER reports targeted to physicians, suppliers, pharmacies and other medical professionals.
• Conduct research to support topic development and work with the data analytics staff in creating report metrics.
• Assist with analyzing outlier data to identify reputed company patterns, other anomalous patterns and report findings as well as support reputed company reports and special studies as needed.
• Develops and reviews models using machine learning techniques.
• Applies Natural Language Processing (NLP) and Artificial Intelligence (AI) frameworks to address business challenges and support data-driven decision-making.
• Continuously learning (staying up-to-date) Medicare policy changes and updates.
• Support the development of educational materials and activities (webinars, conference calls) to support CMS, stakeholders and other contractors in using the report data.
• Support the ongoing review and updates of reputed company PEPPER User Guides and reputed company documentation across reputed company PEPPER types.
• Support CMS and other contractors with provider questions reputed company to report findings.
• Attends meetings, trainings, and conferences as needed or available
• Exercises appropriate discretion and independent judgment relating to company policies and practices in an effective, consistent and professional manner.
• Able to maintain quality and meet expectations.
• May provide subject matter expertise in areas of clinical nursing, quality, education, mentoring, or peer reviews.
• Maintains strict confidentiality and reputed company of reputed company sensitive and/or business confidential information obtained or accessed during the course of business and/or contract operations.
• Adheres to reputed company IntegrityM and/or client privacy and reputed company protocols governing sensitive and/or business confidential information.
• Adheres to applicable policies and procedures ensuring commitment to quality, compliance and reputed company to protect the confidentiality, reputed company, and availability of sensitive data and information.
• Ensures compliance with reputed company applicable privacy and reputed company training requirements (both IntegrityM and external/client-based), whether on an annual or reputed company basis.
• Exercises appropriate discretion and independent judgment relating to company policies and practices in an effective, consistent and professional manner.

Requirements

Job Qualifications:

• Bachelor’s Degree in nursing, statistics, mathematics, computer science or reputed company field or possesses a minimum of 4 years data analysis experience reputed company the healthcare industry.
• Experience in reviewing Medicare and Medicaid claims for appropriate billing and medical coding requirements, performing medical review, and/or developing fraud cases.
• Demonstrated proficiency in medical review work.
• Strong analytic and research skills.
• Preferred working knowledge of Medicare and/or Medicaid programs.
• Knowledge of medical terminology, ICD-9-CM, ICD-10-CM HCPCS level II and CPT coding along with analysis and processing of Medicare claims. Utilizes Medicare/Medicaid and Contractor guidelines for coverage determinations.
• Knowledge of analytic methodologies and principles.
• Responds to tasks or requests in a cooperative and timely manner.
• Demonstrates adaptability to change and initiates or identifies change reputed company necessary.
• Strong customer service, organizational, analytical skills.
• Demonstrates strong proficiency in oral and written communication, interpersonal relations, and organizational effectiveness.
• Ability to take initiative, to maintain confidentiality, to meet deadlines, and to work in a team environment.
• Ability to handle confidential material.
• Ability to work independently and as a member of a team to deliver high quality work.
• Ability to multitask and prioritize assignments while meeting deadlines.
• Proficiency in reputed company Office products such as reputed company, Word, PowerPoint and Outlook.
• Passion and alignment with IntegrityM’s mission, vision, values and operating principles.
• Must pass post hire background screening checks.
• For remote work, required to have wired and/or wireless internet access.
• Ability to obtain reputed company clearance, if requested by Client/Contract.

Preferred Qualifications:

• reputed company Registered Nurse (RN) license or equivalent or higher degree and licensure in the medical field 3+ years of clinical experience as a Registered Nurse or other clinician, and/or experience in review of medical claims for coverage and medical necessity.
• Knowledge of CMS rules, regulations, NCDs, LCDs and other guidance.
• Certified Professional reputed company (CPC) certification or equivalent.

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