Professional Services Solution Product Consultant

by Irma Moore | Mar 5, 2024 | Uncategorized

Job Title:Professional Services Solution Product Consultant

Role Overview:Professional Services Solution Product Consultant

Develop and implement Architecture designs and configuration management in support of information security initiatives. Support integration of SaaS & IaaS applications with McAfee Cloud, based on underlying business needs and supportability. Responsible for Installation, Administration and Maintenance of McAfee Endpoint and Cloud Security Solutions. Develop Security policies for evolving threats and provide expertise to implement and operationalize the policies based on the business needs. Perform Static and Dynamic code Analysis to identify and classify the malware behavior and implement rules to protect endpoints. Conduct hands-on knowledge transfer sessions providing technical mentoring and awareness on the product and its features.

Telecommuting permitted from anywhere in the U.S. May require 25% travel to unanticipated U.S. client locations (5 days at a time).

Requires a Masters degree in Computer Science, Computer Engineering, Electrical Engineering, Electronics Engineering, or related and 2 years of experience.

2 years must include experience with

(1) Writing script, regex, or code in common Programming languages, such as C, Matlab, or Python; (2) Relational, non-Relational databases and query languages like MSSQL or My SQL; (3) OSI Model, TCP/IP protocol suite (IP, ARP, ICMP, TCP, UDP, SMTP, FTP, TFTP); and (4) Computer Organization and concepts of Operating systems (UNIX, LINUX and Windows).

Base Pay Range: $147,500.00 – $273,500.00 per year. Actual base pay within this range will depend on varying circumstances, including the work location, individual qualifications, company budget and other operational business needs. Compensation may also include annual bonuses and long-term incentives, subject to various metrics and company policy.

Junior Revenue Platform Consultant (PST/MST)

by Irma Moore | Mar 5, 2024 | Uncategorized

A Typical Day Might Look Like:

• Sales Technology Configuration and Customization: Tailor our sales technology stack, including Salesforce, to meet business needs, encompassing customizations such as object creation, field adjustments, and layout enhancements.
• Integration Management: Oversee the seamless integration of third-party systems with our sales technology suite, optimizing their performance and functionality within our operations.
• User Lifecycle Management: Streamline user management processes within our technology platforms, from onboarding to offboarding, ensuring smooth transitions and access management.
• User Assistance and Training: Offer continuous support to technology users, addressing queries, resolving issues, and conducting training sessions to enhance their proficiency with the tools.
• Data Integrity Management: Uphold data accuracy and consistency across our technology platforms, overseeing imports, eliminating duplicates, and maintaining clean records.
• Process Streamlining and Automation: Drive efficiency through process automation initiatives, leveraging tools like Flow to streamline workflows and boost productivity.
• Analytics and Reporting: Develop and maintain insightful reports and dashboards that offer valuable sales performance metrics and aid in data-driven decision-making processes.
• Security and Compliance Oversight: Support and maintain robust security measures within our technology ecosystem, managing user permissions and staying up-to-date with compliance standards and updates.
• Versatility: Seamlessly adjust to shifting business demands, fostering efficient and effective outcomes in dynamic work settings.
• Continuous Improvement: Remain updated on industry trends and best practices, exploring new features and recommending optimizations to enhance our technology infrastructure’s effectiveness.

You’ll Be A Great Fit If You:

• Reside in and are authorized to work in the PST/MST time zones in the United States.
• Demonstrate a minimum of 2 years experience as a Salesforce Administrator at a SaaS company.
• Have obtained Salesforce Administration Certification.
• Understand of Salesforce architecture, data model, and security model.
• Have excellent analytical and problem-solving skills.
• Are able to work collaboratively in a team environment.
• Effectively communicate and are able to translate business requirements into technical solutions.

Sr. Healthcare Coordination of Benefits (COB) Data Mining Analyst

by Irma Moore | Mar 5, 2024 | Uncategorized

ABOUT THE OPPORTUNITY:

Hiring Range: 59,500 – 65,000

The Sr. Healthcare Coordination of Benefits (COB) Data Mining Analyst is responsible for objectively and accurately completing conducting audit review and analysis on assigned client inventory, while maintaining high quality work output and successfully meeting productivity and recovery goals.  This position makes identifies trends and makes determinations based subject matter expertise and strong analytical while leveraging audit tools and resources available.  Communicates and supports the identification of additional data mining opportunities and participates in development of ideas as necessary. Able to contribute to resolution of more complex issues or client requirements and may supporting training and guidance to other Data Mining Analysts.

Key Responsibilities

• Conducts COB investigations and associated claims reviews and determines if claims are appropriately paid in accordance with COB rules, commercial billing guidelines and contracts, CMS regulations, and applicable laws and policies.
• Documents findings within audit tracking system and maintains thorough and objective documentation of findings.
• Provides support to client business processes related to claim recovery.
• Investigates, researches, and analyzes claims data, applying knowledge of medical or pharmacy policy to determine proper order of benefits with other payers, both Medicare and commercial.
• Creates narrative rationale to correspond with audit determinations.
• Meets and achieves assigned revenue goals and assigned metrics.
• As needed, supports findings during the appeals process.
• Serves as a senior claims payment resource; provides claims and reimbursement expertise, and guidance to the team.
• Works collaboratively with the audit team to identify vulnerabilities and/or cases subject to potential abuse.
• Monitors, tracks, and reports on all work conducted.
• Consults with our clients, data analysts, other claims payment resources and contractors as necessary.
• Maintains current in-depth knowledge of changes in technology, practice and regulatory issues that may affect our clients.
• Proactively contributes to process improvement activities and sets positive example for group participation and takes ownership in improvement initiatives.
• Actively contributes in quality assurance functions, development of member investigation guidelines and training.
• Proactively identifies and recommends opportunities for cost savings and improving outcomes.
• Serves as positive role model and example for other Analysts.
• May support training and guidance to other Analysts.
• Complies with company policies, processes, and procedures.
• Successfully completes, retains, applies and adheres to content in required training as assigned that includes but not limited to information security, anti-harassment and other compliance and policy/procedures training applicable for position.
• Demonstrates Performant core values in performance of job duties and all interactions.
• Performs other duties as assigned

Knowledge, Skills and Abilities Needed

• Coordination of benefits, medical claims processing, and reimbursement subject matter expertise.
• Depth of knowledge of commercial insurance programs (including billing guidelines and contracts), CMS, regulations and applicable laws and policies.
• Demonstrated ability to apply breadth and depth of applicable business and industry knowledge to developing approaches to customer data mining opportunities as well as continuous improvement initiatives.
• Strong analytical skills.
• Ability to be flexible and seizes the opportunity to cross train.
• Ability to maintain high quality work while meeting deadlines, revenue goals, and performance metrics.
• Excellent organizational, interpersonal and communication skills
• Demonstrated ability to resolve complex problems.
• Ability to serve as a positive role model to more junior staff members.
• Demonstrated ability to train and support team members with less experience with positive interaction and results.
• Must be able to independently use standard office computer technology (e.g. email telephone, copier, etc.) and have experience using a case management system/tools to review and document findings.
• Must be able to manage multiple assignments effectively, create documentation outlining findings and/or documenting suggestions, organize and prioritize workload, problem solve, work independently and with team members.
• Acute sense of professionalism and confidentiality.
• Typing skills and working knowledge of computer functions and applications such as MS office (Outlook, Word, Excel).
• Intermediate to advanced level of proficiency with Microsoft Excel, Word, and Access.
• Capability of working in a fast-paced environment, flexibility with assignments and the ability to adapt in a changing environment.

Required and Preferred Qualifications

• Bachelor’s degree or an equivalent level of competence obtained through experience, education and/or training.
• 8+ years of experience in the health care industry in eligibility or claims analyst type of function.
• 5+ years of experience with clearing houses/claims processing systems (e.g. UNET, COSMOS, NDB, TOPS, FACETS, AMYSIS, MHS, etc.)
• 5+ years working with large volumes of membership or eligibility data.
• Previous COB claims recovery experience required
• Experience with CMS shared data files and CAQH files preferred
• Employment VISA Sponsorship is not available for this position

Certified Hospital Inpatient Medical Coder

by Irma Moore | Mar 5, 2024 | Uncategorized

Remote Hospital Inpatient Coder

This is a full-time, remote/work from home, hourly position on the UCHealth Inpatient Coding team. Potential opportunity for eligible out-of-state applicants. Flexible work schedule. All required hardware/software provided, including dual monitors, keyboard, mouse. Assigns ICD-10-CM and PCS codes using computer-assisted-coding tools, and applies appropriate coding classifications for assigned service lines. 

Job duties

• Responsible for accurately assigning and sequencing ICD-10 CM and PCS codes and POA indicators, identifying query opportunities, and abstracting data based on medical record documentation for all acute care hospital patient types.
• Appropriately applies official coding guidelines and relevant coding references to all inpatient coding scenarios.
• Collaborates with CDI, Quality, and leadership to capture necessary quality measures.
• Enhances coding knowledge and skills with continuing education.

Requirements

• High School diploma or GED
• Coding-related certification from AHIMA or AAPC
• 1 year of Inpatient coding experience OR 3 years of Outpatient coding

Preferred

• Certified Coding Specialist (CCS) highly desired
• 3+ years of hospital inpatient coding experience highly desired
• Level I Trauma coding experience
• Epic experience
• 3M encoder experience
• Computer-assisted coding

The pay range for this position is: $24.11 – $36.17 / hour. Pay is dependent on applicant’s relevant experience.

Drug Rebate Data Entry Clerk – Remote US

by Irma Moore | Mar 5, 2024 | Uncategorized

As a Drug Rebate Data Entry Clerk at Gainwell, you can contribute your skills as we harness the power of technology to help our clients improve the health and well-being of the members they serve — a community’s most vulnerable. Connect your passion with purpose, teaming with people who thrive on finding innovative solutions to some of healthcare’s biggest challenges. Here are the details on this position.

Your role in our mission

• Support staff on daily Drug Rebate activities in scanning payment documentation, posting and reconcile payments timely and accurately in the system.
• Manage deposit spreadsheets and coversheets for all payment sent by drug manufacturers.
• Complete assignments and work products on schedule with quality results.
• Communicate assignment status and escalate issues timely.
• Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA).

What we’re looking for

• PRIMS, Process Manager, SSRS Reports, Remote Desktop Connection experience
• Accounting or Finance experience
• 10-Key proficiency
• Strong knowledge of Microsoft Office (Word, Excel, SharePoint, TEAMS, Outlook)
• Accuracy, efficiency, and attention to detail

What you should expect in this role

This position is remote work.