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Full-time Remote Employee

Integrity Management Services, Inc.

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About Us

Integrity Management Services, Inc. (IntegrityM) is an award-winning, women-owned small business specializing in assisting government and commercial clients in compliance and program integrity efforts, including the prevention and detection of fraud, waste and abuse in government programs. Results are achieved through data analytics, technology solutions, audit, investigation, and medical review.

At IntegrityM, we offer a culture of opportunity, recognition, collaboration, and supporting our community. We thrive off of these fundamental elements that make IntegrityM a great place to work. Our small, flexible workplace offers an exceptional quality of life and promotes corporate-driven sustainability. We deliver creative solutions that exceed goals and foster a dynamic, idea-driven environment that nurtures our employees professional development. Large company perksSmall company feel!

Position Description

In this role, the Data Coach will provide subject matter support to the QSSI client services team to meet established goals and objectives. The Data Coach will make sure that tasks and milestones are achieved on time and that deliverables meet or exceed QSSI quality standards, requirements and needs. The ideal candidate is an accomplished subject matter expert who is passionate in making a real impact on preserving the Medicare Trust Fund. He/she should be a confident public speaker with excellent written and oral presentation skills. The Data Coach should be able to explain, simplify and present complex and sometimes technical functions to staff, users, management, and customer.

Job Responsibilities:

• Provides on-going healthcare fraud, waste and abuse data, tool and analytics support for users when directed by the team and customer.
• Supports the help desk in responding to technical and data questions that are received from end users.
• Builds and maintains positive, productive relationships with colleagues, managers, partners, customer, and users to foster collaboration and consensus.
• Champions the needs of the users and provides recommendations for improving the system capabilities and performance to enhance the value for end users.
• Identifies and recommends policy, procedure, and system changes to enhance project outcomes and performance.
• Conducts data mining, analysis, and reporting using available tools and data sources.
• Prepares and presents live and online subject matter topics to team, customer and end users, and possibly at conferences and tradeshows.
• Works closely with the team to draft and execute an effective end user support and training strategy.
• Assists in the creation and development of various training materials, including trainer guides, training, video or audio, instructor/participant materials, interactive online courseware, and evaluation systems.
• Supports local, offsite and online train-the trainer and end-user training classes with subject matter expertise.
• Interacts frequently and professionally with the customer and stakeholders in a variety of settings including meetings, teleconferences, and written communications.
• Identifies areas for improvement and makes recommendations to increase the quality and effectiveness of support and training processes and materials based on user feedback and industry best practices.
• Stays abreast of industry trends to proactively identify opportunities for fraud or emergent schemes.
• Maintains and reports on various project metrics as required.
• Exercises appropriate discretion and independent judgment relating to company policies and practices in an effective, consistent and professional manner.
• Adheres to applicable policies and procedures ensuring commitment to quality, compliance and security to protect the confidentiality, integrity, and availability of sensitive data and information.

Requirements

• Minimum of a Bachelors Degree in healthcare or business administration, information technology, public health, or a related discipline, or in another relevant field.
• Possesses at least 6+ years recent experience with Medicare and/or Medicaid Part A, B, & DME claims, coding, and reimbursement procedures, service and coverage policies, coordination of benefits, as well as provider and beneficiary eligibility.
• Skilled in MS Office 2007 software or higher version: Word, Excel, PowerPoint and Outlook.
• Must be a team player.
• Understanding of the Centers of Medicare and Medicaid Services (CMS) Integrated Data Repository (IDR).
• Experience with statistical data analysis techniques such as modeling, aggregation, trending, patterns, random sampling, and ratios to identify outliers.
• Ability to review claims for medical necessity, utilization, and level of care to identify aberrant billing practices.
• Thorough understanding of claims and healthcare terminology and codes as published by CPT, ICD, HCPCS, and DRG manuals.
• Excellent analytical and problem-solving skills, with the ability to integrate information from multiple sources to execute effectively and efficiently in a dynamic environment.
• Ability to meet time-sensitive and mission-critical deadlines with minimal supervision.
• Demonstrated performance with high volume data analysis and business intelligence tools such as BusinessObjects, SAS, MicroStrategy, Cognos, etc.
• Able to translate, articulate, simplify and communicate complex business and technical functions to audiences with different level of expertise.
• Superior communication and organization skills are a must with ability to handle multiple tasks in a fast paced work environment and thrive in an environment with regularly changing priorities.
• Confident and results-driven self-starter skilled in taking initiative, assessing requirements, coming up with plans, and taking the lead in making plans reality.
• Experience as a trainer in a classroom setting is desired.
• Experience with Medicare Administrative Contractor (MAC), Recovery Audit Contractor (RAC), Zone Program Integrity Contractor (ZPIC), Program Safeguard Contractor (PSC), or Medicare Drug Integrity Contractor (MEDIC), and other CMS fraud detection and prevention solutions is preferred.
• Experience with SAS or Business Objects for data mining.

IntegrityM is an Equal Opportunity Employer and we do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, and gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.