LLC is recruiting for contract positions for subject matter experts to supplement healthcare fraud detection and analytics efforts for commercial and public payers. The SME will provide guidance, advice and analytical prototype programs or specifications to other analytical and technical staff, perform in-depth technical reviews of existing detection models, review models, programs and result set prepared by other technical staff, create additional algorithms and data analysis for consideration and present results to internal and external teams.
The ideal candidate will possess ten or more years in health care fraud identification and data analysis methods in the payer and/or healthcare fraud and overpayment arena and have expertise in one or more of the following specialties: Acute Care Facility Claims Inpatient Hospital Outpatient Department. Ambulatory Surgery Centers (ASC). Durable Medical Equipment. Home Health. Transportation. Provider Billing/Claims Processing. Required Skills: Excellent writing and oral presentation skills. Medicare and Medicaid policy expertise. Healthcare claims auditing experience. Ability to be productive in a results oriented, fast paced and dynamic environment. Preferred Qualifications: CFE or AHFI credential. Clinical or Medical coding credential. Other pertinent credentials/certifications. Project Management experience These are telecommute positions from any US state.
Based on experience