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Health Management Systems, Inc. Sr. Manager, Developer & PI Analytics in NV, Nevada

HMS makes the healthcare system work better for everyone. We fight fraud, waste, and abuse so people have access to healthcare—now and in the future. Using innovative technology and powerful data analytics, we help government and commercial payers reduce costs, increase quality, and achieve regulatory compliance. We also help consumers take a more active role in their own health. Each year, we save our clients billions of dollars while helping people live healthier lives. At HMS, you will develop new skills and build your career in a dynamic industry while making a difference in the lives of others.

We are seeking a talented individual for driving strategic direction and oversight of HMS ’ Payment Integrity Edits & Analytics Business Solutions, including development and management of Clinical Review edit types, management of production execution of all edits, development and management of master exclusions, Analytics and predictive modeling, reporting, research and special projects. This position will work very closely with internal and external partners, and play a critical role in driving organizational objectives throughout PI Edits & Analytics.

Essential Responsibilities:

  • Project management for internal and external projects

  • Drive process automation throughout department

  • Support Analytics & Predictive Modeling

  • Support Implementation projects

  • Involvement in short and long term strategy for HMS’ PI E&A by advocating for the effective use of technologies, including providing appropriate design and direction to build internal analytical tools and working with outside vendors’ tools to deliver a competitive analytics product

  • Ensure that PI E&A operations are managed effectively, deliver results, and promote a model of operational excellence and continuous improvement

  • Lead and/or participate in forensic analyses related to identified issues that impact the business

  • Lead and/or participate in ensuring that query development, production management, detection and validation activities deliver maximum savings to our customers

  • Monitor each team’s relative business objectives - performance, quality and delivery

  • Develop effective working relationships with key stakeholders

  • Integrate data from multiple sources, from client and/or third party data sources, to complete cutting edge analyses

  • Involvement in support of analytical team in the extraction, aggregation and quality assurance of data from multiple sources in support of PI analytics

  • Research, identify, & implement new approaches and methods to identify billing and coding inaccuracies

  • Develop and deploy best-in-class reporting and analytics to demonstrate the value of HMS’ PI Edits & Analytics products and services

  • Collaborate with IT and business units to advance PI E&A products

  • Effectively communicate workload prioritization and progress to internal and external partners

  • Involvement in support of analytical team in the extraction, aggregation and quality assurance of data from multiple sources in support of PI analytics

  • Research, identify, & implement new approaches and methods to identify billing and coding inaccuracies

  • Develop and deploy best-in-class reporting and analytics to demonstrate the value of HMS’ PI Edits & Analytics products and services

  • Collaborate with IT and business units to advance PI E&A products

  • Effectively communicate workload prioritization and progress to internal and external partners

  • Participate in client discussions and effectively represent subject expertise

Non-Essential Responsibilities:

  • Performs other functions assigned

Knowledge, Skills and Abilities:

  • Possess excellent time management, organizational, and prioritization skills

  • Possess superior interpersonal skills, including excellent written and communication skills, are needed

  • Experience in quantitative and qualitative analysis, relational database, SQL, SAS and other statistical tools, data mining tools

  • Advanced knowledge of Microsoft Office suite including Excel, PowerPoint and Access

  • Familiarity with web-based tools and other reporting tools, data mining skills a plus

  • Possess strong work ethic and high level of integrity

  • Strong leadership and mentoring skills and experience

  • Be proficient in performing forensic analyses

  • Ability to think strategically with appropriate level of detail analysis to plan and execute

  • Ability manage multilevel projects

  • Ability to work collaboratively across the organization

  • Ability to work independently and require minimal supervision

Work Conditions and Physical Demands

  • Primarily sedentary work in a general office environment

  • Ability to communicate and exchange information

  • Ability to comprehend and interpret documents and data

  • Requires occasional standing, walking, lifting, and moving objects (up to 10 lbs.)

  • Requires manual dexterity to use computer, telephone and peripherals

  • May be required to work extended hours for special business needs

  • May be required to travel at least 20% of time based on business needs

Minimum Education:

  • Bachelor’s degree in Arts/Science required, MBA, MPH, or a Master’s degree in Outcome Research, Statistics/Bio-Statistics, Economics, Mathematics or other related field preferred

Minimum Related Work Experience:

  • 5 years’ experience in HealthCare industry

  • Payment Integrity experience a plus

Nothing in this job description restricts management’s right to assign or reassign duties and responsibilities to this job at any time.

HMS is an Affirmative Action and Equal Opportunity Employer who offers a drug-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a disable veteran or veteran of the Vietnam era.

Title: Sr. Manager, Developer & PI Analytics

Location: Nevada-NV-Remote

Requisition ID: 200010T5

EEO/Minorities/Females/Protected Veterans/Disabled.

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