200+ applicants

Company

Wellfleet · 1 day ago

Healthcare Analytics Manager

United States

Full-time

Remote

Mid, Senior Level

$100K/yr - $115K/yr

7+ years exp

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Employee BenefitsHealth Care

Hiring Manager

Katara Slater

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Responsibilities

Lead the implementation and ongoing execution of cost containment strategies

Plan and develop cross-departmental processes to ensure proper controls align with company cost containment strategies

Manage staff, processes, vendors, and related outcomes

Oversee operations that protect the resources of the organization from healthcare FWA

Lead data analysis to identify FWA and cost containment trends and suggest solutions consistent with company strategic initiatives

Develop tools and techniques to proactively identify suspicious claim patterns

Plan, organize, and execute investigations utilizing document review, interviews, and data analysis to identify, evaluate and measure potential healthcare FWA to determine valid cases for appropriate action

Coordinate the review of clinical documentation and collaborate with Clinical team to provide clinical input

Operate with urgency to ensure timely resolution or closure of investigations

Maintain fact-based documentation on investigative findings and retain files in a complete and organized manner

Develop and present verbal and written investigative reports and facilitate meetings

Manage referrals to the SIU and participates in SIU activities

Ensure compliance with applicable state and federal statutes, laws and regulations mandating FWA practices

Proactively seek out and participate in continuing education and development to ensure ongoing alignment with best practices and apply those learnings to enhance internal practices

Conduct 1:1 weekly (or bi-weekly) 'check-ins' with direct reports to identify staff priorities and providing assistance/guidance as necessary

Manage team performance to expectations for department standards, goals and metrics

Ensure departmental KPM’s are met or exceeded

Establish and maintain a supportive learning environment by ensuring continuous development, training, and growth

Conduct team meetings, organizes agenda items to provide staff with clear goals and objectives. Provide prompt communication regarding any changes to procedures/programs

Perform other duties as assigned

Qualification

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FWA investigationsCost containment strategiesMedical claim terminologyClaims editingProvider reimbursement methodologiesData analysisHealth Care AdministrationComputer skillsReport writing

Required

Bachelor's degree in Health Care Administration or related field and 7+ years of experience with FWA investigations and 2+ years of management experience, or a combination of education and experience

Expertise in cost containment strategies, including claims editing and provider reimbursement methodologies

Proven work experience as a team leader or supervisor

Medical claim terminology, coding, and managed care expertise

Ability to work with leaders to develop and document desired business capabilities and be able to translate those into system needs and requirements

Demonstrated ability to effectively develop team members and monitor performance

Exceptional organizational, communication, and interpersonal skills

Detail oriented with strong analytical and critical thinking skills

Ability to make decisions independently in a fast-paced environment

Excellent computer skills and ability to effectively manage spreadsheets, develop presentations, organize files, and write reports

Demonstrates a strong commitment to compliance and ethics

Preferred

FWA/cost containment consulting experience preferred

Benefits

Life, health and dental, vision, 401K retirement plan, short- and long-term disability coverage, flexible/dependent care spending account, tuition reimbursement, and business casual dress.