by Irma Moore | May 16, 2024 | Uncategorized
Job duties:
- Understanding insurance contract terms
- Reviewing underpayments to determine if additional payment amounts can be requested
- Identifying trends in payment discrepancies amongst payers
- Auditing closed balance and write-off claims to ensure accuracy of payment to contract
- Reviewing contract terms for revenue capture and maximization per billing and coding guidelines
- Working with contract management to identify opportunities when negotiating contracts with payers
Revenue Recovery Analysts review large amounts of remittance data and analyze utilizing databases and modeling tools to identify areas of payment variance to contract or revenue optimization opportunities and take steps appeals and corrected claims to resolve and capture the contractual underpayments. Items identified are referred to the Underpayment Specialists for follow-up after identification and initial step to resolution.
Required Minimum Education:
- High school diploma or GED
Minimum Years and Type of Experience:
- 1-2 years experience in healthcare industry.
by Irma Moore | May 16, 2024 | Uncategorized
The Payment Poster identifies and reviews patient accounts, insurance payments and credit balances. Responsibilities may include: data entry, electronically posting payments, creating refunds, reconciling billing and invoices, checking balances, and maintaining patient files.
Qualifications
Minimum Qualifications/Experience:
Two plus years’ of experience in electronic EOB and lockbox payment posting, credit balances to include posting of allowable amounts and reconciliation processes
Two plus years’ of experience in medical billing – preferred
Detail oriented, self-motivated, a problem solver and a team player
Ability to navigate multiple computer screens and browsers quickly and accurately
Ability to excel in a very fast-pace team environment
Ability to continuously “exceed” company and customer expectation
by Irma Moore | May 16, 2024 | Uncategorized
About the Role
We’re looking for someone interested in a position to help us grow our business. As a Data Governance Specialist, you will have a deep knowledge of how data feeds into the business and will design, implement and ensure adoption to a data governance framework. You will define data best practices, policies, and standards both at a technical and functional level. This role will partner with all areas of the business, and align with roles from leadership to subject matter experts to serve as a single point of contact for strategic data needs.
What We Are Looking For
- Bachelor’s degree in business management, statistics, information technology or a related field
- At least 5 years of related experience
- Proven experience developing strategies to improve data process and quality
- Hands on experience with SQL and databases
- Experience with a data catalog software a plus
- Continuous learner who wants to learn and grow with the position and company
by Irma Moore | May 16, 2024 | Uncategorized
Position Summary: Aetna Resources LLC, a CVS Health company, is hiring for the following role in Woonsocket, RI: Sr. Decision Scientist to develop and apply statistical methods to collect, organize, and interpret analytics data and provide usable business information. Duties include: manage large, complex analytics projects including business case development, data exploration, model building, experiment design, and performance evaluation; identify analytic opportunities and data trends and factors affecting the results of research; prepare data for processing and leverage SQL to analyze large, complex data sets to support development of solutions to complex business problems; collaborate with Data Science, Data Engineering, and Business teams to translate organizational problems into an analytics framework and drive development of short- and long-term business solutions and strategies; design experiments to test hypotheses and determine whether statistical methods are appropriate and quantify impact on initiatives; summarize and present statistical and analytical results and create presentations to inform business partners and leadership teams of optimization opportunities and remediation recommendations; and mentor junior staff. Telecommuting available. Multiple positions. –
Requirements: Master’s degree (or foreign equivalent) in Computer Science, Data Science, Statistics, Mathematics, Analytics, Information Technology, Management of Technology, or a related field and two (2) years of experience in the job offered or related occupation.
by Irma Moore | May 16, 2024 | Uncategorized
RESPONSIBILITIES:
●Lead the development of scalable, secure backend systems for our CrossFit Product Platform.
●Design, build, and maintain high-quality REST APIs to facilitate seamless backend integration for partners, as well as flawless interaction with web and mobile clients.
●Design and implement a microservices architecture, optimizing communication and data exchange between components.
●Ensure cloud infrastructure reliability and security, adhering to cloud computing best practices.
●Promote and execute CI/CD pipelines to streamline development and deployment workflows.
●Champion test-driven development (TDD) methodologies to improve code quality and facilitate maintenance.
KNOWLEDGE AND SKILL:
●Proficiency in Python and extensive experience in microservices development.
●Expertise in RESTful API development and integration.
●Skilled in container technologies, orchestration tools, and both SQL and NoSQL databases.
●Knowledge and experience with CI/CD practices and tools.
●A strong advocate and practitioner of test-driven development (TDD).
●Familiarity with data warehouse technologies and strategies, capable of managing large datasets and complex data models.
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