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Latitude, Inc. Sr. Medicare and/or Medicaid Data Coach in Windsor Mill, Maryland

Sr. Data Coach

· Category: Business

· Location: Windsor

Job Summary:

Reporting to the Client Services Lead the Data Coach is responsible for supporting the client services team to meeting established goals and objectives. The coach will make sure that tasks and milestones are achieved on time and that deliverables meet or exceed QSSI quality standards and client?s 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 coach should be able to explain, simplify and present complex and sometimes technical functions to staff, users, management, and customer. The candidate must be an innovative, analytical, thinker to develop conceptual informatics solutions to scientific and social problems.

Job Responsibilities:

o Provide on-going healthcare fraud, waste and abuse data, tool and analytics support for users when directed by the team and customer.

o Support the help desk in responding to technical and data questions that are received from end users.

o Build and maintain positive, productive relationships with colleagues, managers, partners, customer, and users to foster collaboration and consensus.

o Champion the needs of the users and provide recommendations for improving the system capabilities and performance to enhance the value for end users.

o Identify and recommend policy, procedure, and system changes to enhance investigative outcomes and performance.

o Conduct data mining, analysis, and reporting using available tools and data sources.

o Prepare and present live and online subject matter topics to team, customer and end users, and possibly at conferences and tradeshows.

o Work closely with the team to draft and execute an effective end user support and training strategy.

o Assist 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.

o Support local, offsite and online train-the trainer and end-user training classes with subject matter expertise.

o Interact frequently and professionally with the customer and stakeholders in a variety of settings including meetings, teleconferences, and written communications.

o Identify areas for improvement and make recommendations to increase the quality and effectiveness of support and training processes and materials based on user feedback and industry best practices.

o Stay abreast of industry trends to proactively identify opportunities for fraud or emergent schemes.

o Maintain and report on various project metrics as required

Job Qualifications:

o Must have 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.

o Demonstrated performance with high volume data analysis and business intelligence tools such as BusinessObjects, SAS Enterprise Guide, MicroStrategy, Cognos, etc?

o Thorough understanding of claims and healthcare terminology and codes as published by CPT, ICD, HCPCS, and DRG manuals.

o Excellent analytical and problem-solving skills, with the ability to integrate information from multiple sources to execute effectively and efficiently in a dynamic environment.

o Ability to meet time-sensitive and mission-critical deadlines with minimal supervision

o Able to translate, articulate, simplify and communicate complex business and technical functions to audiences with different level of expertise.

o 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.

o Confident and results-driven self-starter skilled in taking initiative, assessing requirements, coming up with plans, and taking the lead in making plans reality.

Educational Requirements

o Bachelor's degree in healthcare or business administration, information technology, public health, or related fields


Job Qualifications Optional

o Experience as a Zone Program Integrity Contractor (ZPIC), Program Safeguard Contractor (PSC), Medicare Drug Integrity Contractor (MEDIC), Medicare Administrative Contractor (MAC), or Recovery Audit Contractor (RAC) is highly desirable.

o Familiarity with the Centers of Medicare and Medicaid Services (CMS) Integrated Data Repository (IDR), One Program Integrity (One PI), Shared Systems, and/or Common Working File (CFW), and other fraud detection and prevention solutions.

o Certified Fraud Examiner (CFE) or Accredited Health Care Fraud Investigator (AHFI) a plus.

o Thorough understanding of Part D Prescription Drug Event (PDE) and Part C encounter data

o Experience with state Medicaid claims and systems such as Medicaid Management Information System (MMIS) or Medicaid and Statistical Information System (MSIS).

o Nursing or clinical experience is desired.

o Certified Professional Coder-CPC or CCS preferred.

o Experience as a trainer in a classroom setting.

o Experience with statistical data analysis techniques such as modeling, aggregation, trending, patterns, random sampling, and ratios to identify outliers.

· Shift: First

· Relocation Assistance: No