高级经理 - 医疗健康索赔数据分析师
Senior Manager - Data Analyst for Medical Health Claims
高级经理 诊断相关组（DRG）专家将支持业务团队，基于历史数据评估产品/服务的使用趋势，例如护理管理趋势、理赔使用情况、会员属性，以开发成本效益高的优质产品/服务。理想的候选人能够获取、整理并开展医疗健康理赔数据的研究/分析，主要目的是识别根本原因，具备主动思考能力，是积极进取的自驱型人才，能够适应快节奏且具有挑战性的工作环境，并具备独立工作能力。候选人应深入了解住院MS-DRG/APR-DRG支付系统，并具备医疗理赔方面的经验或知识。具备门诊、家庭健康、长期护理、行为健康、康复医院、专业服务、医疗器械、健康成本数据理赔经验者优先。有理赔支付和审计经验者也将受益并被推荐。了解医疗理赔术语和保险术语。具备保险公司政策、理赔系统限制、供应商合同条款的经验将非常推荐。具备预付和后付代码编辑/规则开发经验者也建议或鼓励。
该职位薪资范围为：12万 - 12.5万美元
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最初发布于喜马拉雅山
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The Senior Manager Diagnosis Related Group (DRG) SME will support the business team in evaluating trends on utilization of products / services based on historical data - such as care management trends, claim utilization, member attributes, to develop cost effective quality product / services. The ideal candidate retrieves, organizes and performs research/analysis on Medical Health Claim data primarily to identify root cause and is a proactive thinker, self-starter, who enjoys working in a fast-paced and challenging environment with the ability to work independently. Candidate should have a strong understanding of both inpatient MS-DRG/APR-DRG payment systems and have experience/knowledge in health care claims. Additional experience with Outpatient, HH, SNF, BH, IRF, Professional, DME, HCD claims is a plus. Previous claims payment and auditing experience would also be beneficial and recommended. Understanding of Medical claim terminology and insurance terminology. Experience with payer policy, claim system limitations, provider contracting terms are highly recommended. Experience with Pre-Pay and Post-Pay code edit/rules development is recommended/encouraged as well.
Salary Range for this role is: $120k - $125k
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Originally posted on Himalayas