Our client is seeking the services of an experienced Healthcare Claims QA/QC Engineer.
Assignment Length: 3-month contract
# of Openings: 1
Top skills for Healthcare Claims QA/QC Engineer:
- Bachelor’s degree in a quantitative discipline; Masters in Public Health or a related discipline a plus
- Prior experience in working with healthcare claims is a must; Prior work with claims fraud and abuse is preferred
- Expert knowledge of QA/QC Methodologies and the development of business rules is a must
- Strong knowledge of data quality dimensions and ability to analyze data to derive relevant data quality metrics
- Should have experience in data analysis using relational models and SQL
- Proficiency in R and/or Python, with hands-on industry experience, is a must
- Understanding of machine learning and predictive analytics approaches to pattern discovery and anomaly detection
- Outstanding interpersonal and communication skills – Able to work effectively with both the business staff and the technical staff
- Demonstrated storytelling through building visualizations and presentations
As the Healthcare Claims QA/QC Engineer, you will be responsible for:
- Utilize knowledge of healthcare coding, reimbursement methodologies, health plan design, and general areas of vulnerability to develop methods to identify overbilling and fraud in claims data
- Develop explicit QA processes for identifying records that violate established business rules
- Apply programming skills and intuition to explore patterns and outliers in billing and coding of medical claims to develop new models for improper billing practices and fraud, waste and abuse
- Understand healthcare claims fraud and abuse to be able to work with internal and external coders, auditors and SMEs
- Develop novel algorithms and audit methodologies to ensure a reproducible ability to identify billing and fraud issues
- Work with data engineers to implement software modules to consistently monitor claims data feed for any known issues
- Collaborate closely with vendors and internal teams to confirm data and billing issues and to coordinate an intervention
- Work with analytics and operations teams to develop reports and dashboards to bring insights at the right level to the right business users
Don’t miss out on this opportunity. Apply online today!
Eagle is an equal opportunity employer and will provide accommodations during the recruitment process upon request. We thank all applicants for their interest; however, we will only be contacting candidates with the required skills. Please note that your application does not signify the beginning of employment with Eagle. Work with Eagle will only commence when placed on an assignment as a temporary employee of Eagle.