Hi,
*Please send resume to [email protected]* *Business System Analyst with Health Care*** *Location: Owing Mills, MD* *Duration: 6 Months.* *Rate: Open* * * *Job Description:* Submit MTM Audit Memorandums (MAMS) to Operations Management that outline the root cause of identified issues as well as provide recommendations for corrective action, system and procedural modification and enhancements to improve service and quality. Issues may include, but are not limited to: weaknesses, inconsistencies and inaccuracies in procedures, controls and system integrity. Compile, analyze and report any fraudulent activity or information to the appropriate departments. This information or activity may represent a potential risk to the corporation, its subscribers, accounts and providers. The area that may obtain this information may include, but is not limited to: Special Investigations Unit, HIPAA Privacy Office, and/or Compliance Office depending on the nature of the information identified. *MINIMUM QUALIFICATIONS: * Experience /Abilities/Skills: B.S./B.A. degree, or equivalent work experience, along with: A minimum of three years claims/service/enrollment and billing experience or other comparable work experience. Basic understanding of MTM Reporting System Strong knowledge of claims, inquiry, or enrollment processing on a minimum of two platforms: FACETS, FLEXX, NASCO for a minimum of two measures (claims, enrollment, inquiry, group) Moderate understanding of ICD9 coding, CPT coding, medical terminology and the CareFirst Standard Operating Procedures Strong PC skills (Lotus Notes, Word, Excel) Strong analytical and problem solving skills Moderate ability to read and interpret data screens which may include but are not limited to: GMIR, BCIQ, BEI, IACS, CSW, HIQK, OBN, PV40 for two platforms: FACETS, FLEXX, NASCO Ability to read and interpret contracts Ability to research and document audit issues Basic knowledge of statistics Ability to make independent decisions Strong interpersonal skills Ability to interact with multiple levels of Associates & Management Ability to multi-task and change priorities as needed Ability to work both independently and as a member of a team Effective communication skills (verbal and written) Professional attitude & professional attire required Preferred: Two or more years Quality Assurance experience. -- You received this message because you are subscribed to the Google Groups "KNOW.IT" group. To post to this group, send email to [email protected]. To unsubscribe from this group, send email to [email protected]. For more options, visit this group at http://groups.google.com/group/know_it_az?hl=en.
