Hi Friends,

Please send resumes to *[email protected] *or can reach me at *
972-746-4355
*

*
*

*
*

*Duration: 3-6 Months*

*Location: Baltimore, MD (Locals only)*



Design algorythyms and data models to monitor Medicaid waste and fraud
abuse. SQL and Medicaid claims exp strongly preferred.



The Healthcare business of Client is seeking an analytic consultant
withMedicaid experience to
provide insight into the design and development of algorithms used to detect
incorrect or fraudulent Medicaid payments to healthcare providers.  The
successful candidate will have an extensive background in analytics,
Medicaid and healthcare information, be proficient in utilizing information
technology systems to locate and examine healthcare claims data, and be
familiar with Medicaid policy.  The candidate must also have the ability to
work both independently and collaborative as part of a team.



Qualifications:

   - Bachelor's degree in healthcare or an analytical field (i.e., Public
   Health Administration, Statistics, Biostatistics, Applied Mathematics,
   Psychology, Sociology, etc.).  Degrees in both healthcare and analytics are
   a plus.
   - 3 years of experience working with healthcare information.
   - 3 years of direct Medicaid experience (either working for a Medicaid
   agency or working with a company or healthcare provider on the correct
   coding and billing of Medicaid claims and adherence to Medicaid policy).
   - 3+ years of experience examining healthcare claims.
   - Proven task management skills.
   - Strong analytical skills.
   - 3+ years of experience utilizing information technology systems (i.e.,
   healthcare claims databases, etc.) to retrieve and examine healthcare claims
   data.
   - Excellent writing and oral presentation skills.
   - Familiarity with medical coding (i.e., ICD-9, CPT, CDT, HCPCS, etc.) is
   a plus.
   - Extreme attention to detail.
   - Experience in detecting incorrect or fraudulent healthcare payments a
   plus.
   - Proficient in Microsoft Word, Excel, and Outlook.  Experience with SAS,
   SQL, SharePoint, or Oracle databases a plus.
   - A professional healthcare license (RN, LPC, MD, etc.) is a plus, but
   not required.
   - Willingness to travel.

Responsibilities:

   - Review Medicaid claims data to assure that the claims: (1) are
   compliant with applicable Medicaid policy; and (2) are otherwise correct.
   - Review the design and development of algorithms to identify ways to
   detect more incorrect and/or fraudulent Medicaid claims and remove claims
   which are allowable under Medicaid policy from the algorithm’s results.
   - Draft reports and analyses regarding healthcare data and information.
   - Conduct quality assurance of all work products produced and those of
   peers.
   - Identify opportunities for the creation of algorithms and data models
   to detect incorrect or fraudulent Medicaid billings.
   - Execute task leadership and sub-task management on small to mid-size
   projects; complete assignments on time.
   - Interact with clients in a professional manner and respond quickly to
   client requests.
   - Interact with project team in a collegial and professional manner.
   - Help foster teamwork to complete designated tasks.







Thanks & Regards,

*Srikanth K*

*American Softech Inc.,*

Direct   :  972-746-4355

Ext       : (972) 746 4350 ext 1005

Fax      : (972) 600 - 8569

Email   : [email protected]

www.amsoftech.com

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