Job Closed

This listing is no longer active.

Integrity Management Services, Inc. logo
Integrity Management Services, Inc.

An elevated approach to program analysis.

SIU Analyst – Investigator

Location

Virginia

Posted

40 days ago

Salary

0

Seniority

Mid Level

Bachelor Degree2 yrs expExperience acceptedEnglish

Job Description

SIU Analyst – Investigator

Integrity Management Services, Inc.

• Identify and conduct investigations into known or suspected FWA with high autonomy • Develop documentation to substantiate findings, including formal reports, graphs, audit logs, and other supporting documentation. • Perform root cause analysis to inform future algorithmic identification of similar claims or cases and associated savings (i.e., help move identified case types from "pay-and-chase" to preventive edits and pre-payment activity) • Participate in the development and presentation of FWA-related education for assigned Customers • Perform coding reviews for flagged claims, to support Coding team (if applicable).

Job Requirements

  • Education:
  • Bachelor's degree in Criminal Justice or a related field, OR at least 3 years of insurance claims investigation experience or professional investigation experience with law enforcement agencies.
  • Experience:
  • Minimum of 2 years of experience in healthcare claims analysis, auditing, payment integrity, or a related field.
  • Knowledge of applicable fraud statutes and regulations, and of federal guidelines on recoupments and other anti-FWA activity
  • Experience handling confidential information and following policies, rules, and regulations
  • Experience with commercial, Medicare, or Medicaid claims is highly preferred.
  • Skills:
  • Strong analytical and problem-solving skills, with attention to detail and accuracy.
  • Excellent communication skills, both written and verbal, for effective collaboration with internal teams and external providers.
  • Proficiency in Microsoft Office, particularly Excel, and familiarity with claims processing or audit software is a plus.

Related Categories

Related Job Pages

More Analyst Jobs

Carilion Clinic logo

EPIC Application Analyst III – HomeHealth/Hospice

Carilion Clinic

Improving the Health of the Communities We Serve

Analyst40 days ago
Full TimeRemoteTeam 10,001+Since 1899H1B No Sponsor

• Responsible for performing Epic application system analysis and design to include requirements, specifications, configuration, documentation, testing, and implementation of systems • Will also be involved in providing Epic application support, troubleshooting, training and reporting activities • May also be involved in providing non-Epic application support and troubleshooting for integrated third-party applications • Serves as a liaison between TSG groups, clients and vendors • Conducts advanced analysis of Epic application design including but not limited to planning implementations and maximizing application benefits • Mentors teammates in resolution of issues, tracking issues and providing updates to peers, leadership and clients • Manages assigned projects and meets deadlines • Conducts highly complex work unsupervised and with extensive latitude for independent judgement • Adheres to departmental policies and procedures • Plans and conducts requirements gathering for Epic projects and requests • Coordinates, plans and conducts detailed design sessions through knowledge of client/business needs and application functionality • Develops reference materials (status reports, documentation, knowledge transfer, etc.) for supported applications (Epic and non-Epic) and related technologies • Serve as a liaison between Epic modules • Serve as a professional and technical mentor to teammates • Recognized as a subject matter expert and advanced individual contributor • Serve as advocate for department initiatives and processes • Facilitates a positive and collaborative work environment • Adheres to the application change management process to include timely reporting of all pertinent change information, effective discussion of the changes, internal and external communications, contingency planning, support of the change event and post-change reporting, as appropriate

Alabama + 9 moreAll locations: Alabama | Florida | Kentucky | Louisiana | North Carolina | Mississippi | South Carolina | Tennessee | Virginia | West Virginia
Job Closed
Albieri e Associados logo

Accounting Analyst

Albieri e Associados

Albieri e Associados agora é Andersen Consulting

Analyst40 days ago
Full TimeRemoteTeam 201-500Since 2012H1B No Sponsor

• Responsible for processing datasets in Excel or TXT files and cross-referencing data; • Report directly to management on activities performed; • Understand the accounting procedures and principles applied by the client; • Prepare fiscal and accounting databases; • Use and analyze data through spreadsheets; • Direct client contact; • Document review and analysis; • Create keys for cross-referencing information; • Define logical criteria together with the IT team; • Control and categorize invoices and accounting entries; • Organize documentation in PDF format; • Prepare management summaries based on collected analytical data.

Brazil
Job Closed
Thermo Fisher Scientific logo

Resource Analyst

Thermo Fisher Scientific

Thermo Fisher Scientific is a global biotechnology product development company whose mission is to make the world healthier, cleaner, and safer. Thermo Fisher Scientific leads a gl

Analyst40 days ago

Title: Resource Analyst - Remote, Mexico - Remote, São Paulo, Brazil - Remote, Argentina Full time Remote As a Resource Analyst, you will forecast, track and identify resource allocation needs, assignments, and availability for assigned projects. You will support the efficient utilization and forecasting of labor needs of clinical resources in each assigned geographical area through evaluation and analysis. Responsibilities also include ensuring appropriate composition of project teams to enable presentation of appropriate clinical teams to clients and impacting the performance and profitability of project teams from a quality, operational and financial aspect across all therapeutic areas. What You'll Do: • Track and identify resource needs and assignments. Coordinate the intake, up and resolution of all resource requests. Maintain project module in the system. • Evaluate resource requests, availability and assignments with other areas to assure resourcing needs in all areas are met. Identify staff for assignments based on client requirements, employee background, therapeutic requirements, geographical area, availability. • Lead weekly resourcing needs and meetings. Distribute resourcing reports. Update roll-off dates and assignments for all clinical resources of projects managed by respective area. Actively participate and contribute to agenda/discussion during routine meetings for area Resource Analysts. • Liaise with internal departments to prioritize resourcing needs and assignments for future work, RFPs and bid defense meetings. • Utilize resourcing dashboards, and other available tools to reconcile and QC departmental reports, including monthly resourcing projections and utilization reports for senior management. • Identify and submit proposals of available resources based on availability and experience. • Undertake special projects with a goal of ongoing improvement and streamlining the resourcing function including long range metrics and projections. • Mentor and assist in training of new staff as necessary. Education and Experience Requirements: • Bachelor's degree or equivalent and relevant formal academic / vocational qualification • Previous experience that provides the knowledge, skills, and abilities to perform the job (comparable to 2+ years’) or equivalent combination of education, training, & experience. In some cases an equivalency, consisting of a combination of appropriate education, training and/or directly related experience, will be considered sufficient for an individual to meet the requirements of the role. Knowledge, Skills, Abilities: • Knowledge of project resourcing and forecasting and applicable tools for tracking and forecasting needs • Proficient knowledge of MS Office including Outlook and Excel • Effective problem solving and facilitation skills • Knowledge of relational databases and ability to generate reports • Able to gather, interpret and evaluate information from a variety of resources to make decisions and recommendations • Good quantitative and analytical ability • Excellent attention to detail • Able to manage multiple projects and multitask with little supervision • Good verbal and written communication skills • Knowledge of expectations and resourcing needed to effectively staff project teams to promote business goals and future authorizations

Argentina + 2 moreAll locations: Argentina | Mexico | Brazil

Pharmacy Contract Audit Analyst

Navitus Health Solutions

Navitus Health Solutions is a group that seeks to make medications more affordable so that people can experience better health. It utilizes a 100% pass-through

Analyst40 days ago

• Responsible for the oversight of Navitus’ contractual pharmacy network reimbursement accuracy • Make independent assessments to confirm Navitus is conforming to contractual reimbursement obligations • Review and monitor claims data, create, and update procedures • Audit networks for price change accuracy, monitor compliance with Navitus pharmacy provider contracts • Communicate findings, and work with applicable teams to remediate errors • Analyze provider, client, and network performance for quality control and compliance • Create reports to validate systems accuracy to Retail, Specialty, and Mail Order contractual terms

Idaho
$52.7K - $62.7K / year