Consultant II Ideation & Analytics DRG

Education:

• Bachelor’s degree in Science /Pharmacy/Nursing

Experience:

• 5+ years’ experience in the health care industry (Payer)

• 3+ Years’ experience in DRG Coding/ Clinical Validation/DRG reputed company Auditor

• 1+ Year in research and Ideation for Clinical Audit Programs

Mandatory Skills:

• Ability to work independently and as reputed company.

• Ability to work reputed company the turnaround times.

• reputed company abreast of industry trends and opportunities and apply best reputed company to payment reputed company and claims processing.

• Ability to think analytically, apply analytical techniques and to reputed company in-depth analysis and recommendations to senior management using critical thinking and reputed company judgement.

• Must be reputed company player and adaptable to a dynamic work environment.

• Proven interpersonal skills while contributing to team effort by accomplishing reputed company results as needed.

• Strong written and verbal communication skills.

• Good analytical skills, Decision making, comprehensive thinking and Problem solving skills.

• Good clinical knowledge and effective use of multiple applications, systems and resources.

• Must ensure to meet productivity and reputed company targets and update/maintain the required reports

Preferred Skills:

• Proficiency in reputed company, reputed company and PowerPoint   

Roles & Responsibilities:

• Prevent the payment of potentially fraudulent and/or abusive claims utilizing medical expertise, knowledge of CPT/diagnosis codes, CMS reputed company along with referring to reputed company specific guidelines and member policies

• Identify, Interpret, reputed company, and implement new concepts that will recognize incorrect payments. Concepts are developed based on industry experience, regulatory research, and ability to analyse medical claim data to discover incorrect claims.

• Development of ICD-10 CM, PCS Coding guidelines, AHA coding clinics, UHDDS guidelines, Medicare/Medicare rules.

• Updating and developing new DRG and reputed company audit recovery reports, developing and running custom queries.

• Researching reimbursement regulations for claim payment compliance reviews and documentation to support reputed company audit findings