Employer: | SCIO Health Analytics/EXL |
Type: | PER DIEM, FULL TIME |
Skills: | DRG,Per Diem,RUG,OASIS,Fee Schedule |
Specialties: | Medical Claims Processing |
Required Experience: | 3 to 4 years |
Preferred Experience: | 5 to 7 years |
Location: | 12276 San Jose Blvd, Suite 410,Jacksonville 32223, FL, US |
Date Posted: | 12/27/2018 |
SCIO Health Analytics/EXL Company is looking for an experienced Manager of Data Mining. This is a Home Office opportunity. The Manager of Data Mining is responsible for oversight of the day-to-day functions of the assigned program. This includes but is not limited to supervision of employees, training, quality assurance, and management of new concepts.
KEY DUTIES AND RESPONSIBILITIES:
- Direct and manage the data mining process from beginning to end.
- Answer questions from Auditors, Analyst, Senior Analyst, and Quality Analyst.
- Ensure Auditors and Quality Auditors are meeting production and quality expectations.
- Assist with new query development.
- Ability to present program updates and issues to clients and internal management in a professional manner.
- Work with clients on questions or requests that would impact identifications of overpayments.
- Mentor assigned staff and when necessary conduct disciplinary action.
- Ensure adjustments are made to queries based on client disputes/feedback.
- Ensure Audit Coordinators are performing tasks in a timely manner.
- Work with team to ensure project priorities and timelines are met.
- Update department reports defined by Management.
- Ensure assigned staff has all the necessary tools in order to perform job.
- Work with team to ensure project priorities and timelines are met.
- Update department reports defined by Management.
- Ensure assigned staff has all the necessary tools in order to perform job.
- Manage/Assist training of new assigned staff.
- Handle responsibilities of assigned staff that are not performed/covered.
- Understands claim processing for assigned clients.
- Will perform other duties as assigned
SUPERVISORY RESPONSIBILITIES:
Will supervise: Auditor, Analyst, Senior Analyst, Quality Auditor
QUALIFICATIONS:
- College Degree or Equivalent Work Experience
- 3-5 Years Experience with Medical Claims Processing
- 2-5 Years Experience with various types of Medical Health Care Claims Processing including but not limited to: Types of Claims: (DRG, Skilled Nursing, Home Health, Durable Medical Equipment) and Payment Structures (DRG, Per Diem, RUG, OASIS, Fee Schedule)
KNOWLEDGE AND SKILLS:
- Attention to Detail
- Proven problem-solving abilities
- Excellent written and oral communication skills
- Effective Time Management Skills
- Highly self-motivated and directed
- Flexible during times of change - Adjust to shifting priorities and timelines through analytical and problem solving capabilities
- Must be able to learn, understand, and apply new technologies
- Professional Communication
- Ability to travel to client locations as business needs dictate