by twochickswithasidehustle | Nov 5, 2024 | Uncategorized
Overview
Now hiring a Health Care Investigator.
- Remote: Open to remote applicants in the United States, except for the following states: Wyoming, North Dakota, and Ohio
The SIU Investigator III supports Program Integrity Department initiatives at Presbyterian Health Plan. The Special Investigative Unit (SIU) Investigator III is responsible for conducting medium to highly complex reviews into suspected or actual healthcare fraud, waste, or abuse with respect to provider, pharmacy, employee, member, and broker interactions involving the full range of products at Presbyterian. This includes the identification, investigation, prevention, and reporting of fraudulent, wasteful, and/or abusive billing and/or coding practices and/or patterns; requesting and reviewing medical record documentation to determine if services billed were rendered and/or appropriate based on documentation; interviewing suspect(s) and/or witness(es) with knowledge of the suspect and/or actual fraud, waste, or abuse; coordination of recovery of overpayments related to fraudulent, abusive, and/or wasteful billing and/or coding practices; and providing education related to coding/representation of services and appropriate medical record documentation requirements. The ideal candidate should have proficient experience in healthcare claims fraud, waste and abuse investigation, with experience in government funded programs like Medicaid, Medicare, and the Marketplace, along with Commercial health plans, to include Federal Employee Health Benefits Plan, and Self-Funded accounts.
How you belong matters here.
We value our employees’ differences and find strength in the diversity of our team and community.
At Presbyterian, it’s not just what we do that matters. It’s how we do it – and it starts with our incredible team. From Information Technology to Food Services and beyond, our non-clinical employees make a meaningful impact on the healthcare provided to our patients and members.
Why Join Us
- Full Time – Exempt: Yes
- Job is based Rev Hugh Cooper Admin Center
- Work hours: Days
- Benefits: We offer a wide range of benefits including medical, wellness program, vision, dental, paid time off, retirement and more for FT employees.
Qualifications
- Bachelors degree, plus three years related healthcare experience required. Six years of additional experience can be substituted in lieu of degree.
- Certified Professional Coder (CPC) through the American Academy of Professional Coders (AAPC) or equivalent required
- Preferred Qualifications
- Certified Professional Medical Auditor (CPMA) through the AAPC
- Certified Fraud Examiner (CFE) or Accredited Health Care Fraud Investigator (AHFI)
Responsibilities
- Medium to high complexity reviews/investigations involving provider, pharmacy, employee, member, and broker issues
- Must be able to perform in-depth and complex medical coding audits in both an accurate and timely manner as part of the Special Investigative Units proactive effort, as well as referral-based issues, that are brought to the attention of the unit
- Strong and accurate technical and report writing skills are required, as case management documentation, reports and/or referrals to government agencies, and legally binding documents are produced and handled by the SIU
- Maintain accurate, current, and detailed case information in the SIU case management system
- Strong verbal communication skills are required due to interface with government agencies, providers, and internal departmental collaboration
- Strong analytical skills necessary as this position will require interface with health plan claims system, the vendor fraud analytics system, the SIU case management system, and other systems utilized by the SIU in investigating fraud, waste, and abuse allegations
- Ability to work independently to achieve Program Integrity Department and SIU objectives.
- Critical thinking and attention to detail
- Resolving conflict that arises from provider audit results and/or issues resulting from a fraud, waste, or abuse investigation
- Conduct research into coding rules and/or guidelines, or other state or federal rules and/or laws depending on the nature of the suspect fraud, waste, or abuse
- Maintains caseload and manages daily case review assignments and productivity standards with attention and accountability towards achieving a quality product
- Monitor cases post-audit to determine if continued aberrancies exist that require additional follow-up and review
Intermediate level of:
- Ensures adherence to state and federal laws and regulations, managed care awareness, along with reimbursement and coding policies and guidelines, to include internal Presbyterian Health Plan enterprise operations, functions, and processes
Intermediate level using:
- MS Office (Word, Excel, PowerPoint)
- Adobe Pro
- Internet
- Microsoft Teams and/or Zoom
- In collaboration with SIU Manager and Senior Investigator, manages the overall direction, coordination, implementation, execution, and completion of assigned investigations ensuring consistency with department strategy, commitments, and goals
- Responsible for concurrent and/or retrospective review, data abstraction, analysis, identification of critical issues, process improvement support, required education, and assisting with measurement of performance metrics
- Serves as resource recommending process modifications and practice changes to improve efficiency, effectiveness, and reliability of processes and systems
- Builds and develops collaborative relationships vital to the success of cases and department
- Conducts advanced fraud, waste and abuse audits in accordance with compliance and audit work-plan and prepares detailed audit reports for management, legal counsel, and providers
- Identifies, investigates, and resolves billing and coding related inquiries and complaints from beneficiaries, members, regulatory agencies and internal and external customers through recoupment of overpayments and education to providers
Benefits
All benefits-eligible Presbyterian employees receive a comprehensive benefits package that includes medical, dental, vision, short-term and long-term disability, group term life insurance and other optional voluntary benefits.
Wellness
Presbyterian’s Employee Wellness rewards program is designed to provide you with engaging opportunities to enhance your health and activate your well-being. Earn gift cards and more by taking an active role in our personal well-being by participating in wellness activities like wellness challenges, webinar, preventive screening and more.
by twochickswithasidehustle | Nov 5, 2024 | Uncategorized
Scheduled Hours
37.5
Position Summary
This position provides payroll support to multiple departments within the School of A&S. Will work as a team to ensure backup coverage as necessary within the school or dean’s office. Areas for support and systems used may expand or change as the role develops.
Job Description
Primary Duties & Responsibilities:
- Enters and maintains all faculty, staff, and student Workday-HCM data for multiple assigned departments.
- This includes monitoring and tracking relevant job data, contract data, sourcing information, as well as maintaining leaves, breaks in service, and terminations.
- Also includes posting job openings, helping departments manage searches in the search system of record, and onboarding new employees.
- Payroll
- Includes oversight of pay-cycles and meet all payroll deadlines (MON, BWK, and STP) for assigned departments.
- Review time and labor activities for each pay cycle.
- Ensure employees are paid accurately, timely, appropriately and sourced to proper funding sources in compliance with policy and regulations.
- Process payroll cost transfers as necessary to resolve payroll allocation problems.
- Audit time reporting and ensure proper data entry for absence management and short-term disability.
- Specialized Graduate Students
- Work with Arts & Sciences Graduate School to ensure graduate students are supposed by assigned departments are processed accurately and timely in accordance with Graduate School guidelines.
- Work with the A&S Manager of HR and Payroll and the other A&S payroll coordinators to cover workflow and tasks for cross-coverage as needed; work with the manager on auditing and correcting errors across the A&S dataset.
- Coordinate Federal Work Study funds for student workers in partnership with Students Financial Services and Sponsored Projects Accounting for assigned departments.
- Work with OISS to assist foreign faculty, post docs, graduate students, and undergraduate students to ensure accuracy of federal documents used for Form I9 purposes.
Working Conditions:
Job Location/Working Conditions
- Normal office environment.
Physical Effort
- Typically sitting at desk or table.
- Repetitive wrist, hand or finger movement.
Equipment
The above statements are intended to describe the general nature and level of work performed by people assigned to this classification. They are not intended to be construed as an exhaustive list of all job duties performed by the personnel so classified. Management reserves the right to revise or amend duties at any time.
Required Qualifications
Education:High school diploma or equivalent high school certification.
Certifications:No specific certification is required for this position.
Work Experience:Human Resources, Personnel, And Payroll (3 Years)
Skills:Human Resources Processes, Microsoft Office
Driver’s License:A driver’s license is not required for this position.
More About This Job
Washington University seeks highly motivated individuals who are able to perform duties in a manner consistent with our core mission and guiding principles.
Preferred Qualifications
Education:Bachelor’s degree
Certifications:No additional certification beyond what is stated in the Required Qualifications section.
Work Experience:Payroll (5 Years)
Skills:Adaptability, Confidentiality, Deadline Management, Detail-Oriented, Higher Education Administration, Interpersonal Communication, Multitasking, Oral Communications, Organizing, Positive Thinking, Workload Prioritization, Written Communication
Grade
G08-H
Salary Range
$21.17 – $32.85 / HourlyThe salary range reflects base salaries paid for positions in a given job grade across the University. Individual rates within the range will be determined by factors including one’s qualifications and performance, equity with others in the department, market rates for positions within the same grade and department budget.
by twochickswithasidehustle | Nov 5, 2024 | Uncategorized
Position Description
At a Glance
Legrand has an exciting opportunity for a Data Steward II to join the Electrical Wiring Systems Syracuse Team. This is a remote position reporting to West Hartford, CT. This role will report directly to the Product Data Manager and will have a matrix line of reporting to a business division product data lead for alignment with business needs and goals.
The Data Steward will combine a base of solid product knowledge with a strong grasp of structured data hierarchies, dependencies, and relationships to help Legrand business division/sector ensure that product data is available, complete, consistent, and in the format needed for digital marketing and eCommerce.
The Data Steward will understand how master data and web content management systems pull information from various locations to deliver an on-page experience for the web user that helps website users find the right product and gather the necessary information for decision-making. The successful candidate demonstrates a firm understanding of data management fundamentals and can work collaboratively with Product Data Quality (PDQ) and business division stakeholders to document requirements in adherence with data standards.
What Will You Do?
- Manage all the content (product specifications, descriptions, titles) that are pulled into the product detail pages across the Division’s websites (including myLegrand; legrand.us; cables to go)
- Manage all data projects across the division, including individual business unit initiatives aimed at improving product data information.
- Coordinate with relevant stakeholders to ensure all data on the websites reflects entire business requirements, including Product Management, Product Marketing, Engineering, and Marketing.
- Follow guidance from the Central Marketing and IT teams and make recommendations as it pertains to data taxonomy updates and system configurations.
- Work within the product content management (MDM) tool to manipulate and structure data in one-off or bulk edit situations. Responsible for managing and maintaining the data within the MDM tool.
- Work within syndication systems we subscribe to, to manipulate and structure data for import into those systems. Responsible for managing and maintaining the data within the syndication systems.
- React to and resolve all product data complaints and feedback that comes into the website and syndication systems from users, including updating incorrect content, tracking down missing content, performing root cause analysis, etc.
- Request data adaptations and manipulation within the data structure and taxonomy by following established processes.
- Represent the Division product data needs as a member of the LNCA Data Governance/Steward Council.
- Recommend and manage the new product introduction process to ensure all product pages for a product launch include all required data.
- Act as a super-user of the MDM and syndication systems, understanding the capabilities of the system and downstream impact/process flows.
- Support the customer data needs for 3rd party aggregators, custom content providers, direct customer syndications, uploads, inquiries, etc.
- Pursue cleanliness and completeness metrics from the LNCA Central Marketing team by proactively searching the MDM for missing or incorrect data.
- Follow all rules and guidance governing LNCA product data and propose updates to standards as needed.
- Perform other similar and related duties as required.
Qualifications
Required Skills
Education:
- Associates degree in business or equivalent combination of education and experience.
Experience:
- Minimum of 2 years’ experience in data management, customer service, product marketing or related.
Preferred Skills:
- Data Management Professional (CDMP) certification preferred.
- Foundational knowledge of DMBoK data management foundations preferred.
- Familiarity with modern database and information systems technologies, including ERP and MDM.
- Understanding of ecommerce fundamentals preferred, including: base/variant relationships; category-specific product attributes; and attribute inheritance by category/subcategory.
- Advanced Excel experience preferred.
- SAP, JD Edwards (JDE) or Dataworks knowledge preferred.
Skills/Knowledge/Abilities:
- Must be able to work both independently and with other associates within the organization.
- Requires strong organizational and time management skills. Close attention to detail and able to effectively multi-task is essential.
- Must have strong computer skills, demonstrate proficiency with word processing, spreadsheet and presentation software, e-mail and meeting management software. Ability to use internet and web-based resources efficiently and effectively.
- Must have exceptional customer service skills
- Strong verbal and written communications skills required to communicate effectively across all levels of the organization in order to address roadblocks, challenges or resourcing issues. Willing to follow processes and ask questions for clarity.
- Ability to learn new systems and differentiate between dynamic fields that can/should be changed over time versus static fields (will be provided with the guidance, forms, and processes to request those changes).
- Ability to act as a change agent to streamline and adapt system processes over time.
- Confidence to push back on missing or incomplete datasets.
- Ability to focus on a repetitive task for an extended period.
by twochickswithasidehustle | Nov 5, 2024 | Uncategorized
Summary
The HR Data Analyst will collect, organize, interpret, and summarize human resource data to provide usable information to assist HR with decision making, policy formulation, workforce planning or other Human Resource functions. This person will provide regular reporting (eg: via Excel and Workday) as well as devise methods for identifying data patterns and trends in available information sources while offering project support on various HR initiatives.
REMOTE work from HOME
Essential Functions
- Support reporting needs across all HR functions including configuration for new reports, troubleshooting existing reports, and advising on potential reporting solutions available within Workday
- Support and participate in the HR data lifecycle including data extraction or gathering from multiple sources; prepare data for analysis including file merging, data cleaning and entering formulas; create metrics (calculations based on past and future trends) and analytics (making recommendations for future activity) and reporting information through data visualization techniques (such as charts and graphs) as well as through mathematical calculations and/or advanced statistical analyses (such as regression, correlation, ANOVA, etc.) as needed; and maintain and update files including weekly, monthly and quarterly reports.
- Consult with HR stakeholders, using data, metrics, and analytics to identify recommendations and feedback for HR policies and initiatives
- Provide ongoing support to HR projects and initiatives including schedule planning, task tracking, communication/correspondences with team member or key operatives, and reporting relevant trends
- Meet with HR stakeholders to understand business requirements in order generate data driven solutions
Additional Responsibilities
- Performs other duties as assigned.
Skills and Abilities
- Ability to present information and ideas clearly and understandably to others
- Ability to quickly respond to changing assignments, work settings and priorities
- Demonstrates analytical skills
- Demonstrates problem solving skills
- Excellent interpretation of complex statistical data
- Ability to create unique ideas or combine existing ideas to obtain a new or unique result
- Ability to read and/or listen and understand information and ideas communicated
- Ability to manage multiple assignments and tasks, set priorities, and adapt to changing conditions and work assignments
- Ability to easily calculate, compute, organize, understand and solve numerical and quantitative problems
- Ability to find solutions to problems using creativity, reasoning, and past experiences along with the available information and resources
- Ability to maintain confidential information
- Demonstrates a high level of accuracy, even under pressure
- Study, scrutinize, examine data, people, or things scientifically
- Capable of multi-tasking, highly organized, with excellent time management skills
Qualifications
- Bachelor’s degree required preferably in a quantitative discipline such as mathematics, statistics, economics, computer science, MIS or related field.
- Master’s degree preferred industrial/organization psychology.
- One (1) year or more collecting, organizing, interpreting and presenting simple and advanced analyses, experience with Microsoft office including Excel, Access, Word, PowerPoint, experience using data visualization tools such as Tableau or Excel Pivot Table required
- One (1) year or more with Microsoft SharePoint and HRIS data and systems, preferred
- One (1) year or more creating Workday Custom Reports & Calculated Fields
by twochickswithasidehustle | Nov 5, 2024 | Uncategorized
Date: Oct 30, 2024
Location:
Remote, Remote, US
Requisition ID: 12361
Description:
The Data Entry Operator is an entry level position which is production oriented. Individuals are responsible for the introduction of data into the system which is then provided to the client for use in their internal adjudication system.
FOUNDATION KNOWLEDGE, SKILLS, AND/OR ABILITIES REQUIRED
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions
ESSENTIAL DUTIES AND RESPONSIBLITIES
• Enter data from scanned and/or processed images into the data capture system.
• Meet expected hourly production volume goals.
• Maintain quality levels above minimums set by management
• Increase speed and difficulty of tasks as expected with training and practice
•
ADDITIONAL RESPONSIBILITIES
• Maintain awareness of and actively participate in the Corporate Compliance Program.
• Maintain a neat and orderly workstation.
• Assist with other projects as assigned by management
• Must be prompt and dependable (excellent attendance)
• Must be comfortable working in a production environment
• Proficient typing skills are required (35wpm / 98% accuracy min) (test required).
• Possess excellent organization skills
• Reliability of task completion and follow-up
Qualifications – External
EDUCATION/PREVIOUS EXPERIENCE
High School diploma or equivalent
Excellent Data Entry Skills
Computer Knowledge
Basic Math Skills
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