• Watson Health - Client Services Manager , Data Analytics Jobs in United States Of America

  • IBM India Pvt Ltd
  • United States Of America, Usa
  • Save Job
  • 5 - 8 Years
  • Posted : above 1 month

Job Description:

IBMs Industry Consultants are essential to our clients as they work to reinvent themselves for the future Join our highly visible and highly skilled team of global consultants as we strive to accelerate sales, deliver client engagements, and build IBMs market eminence If you are a forward-thinker and a curious intellectual, we welcome you to apply for your next exciting career challenge!

Your Role and Responsibilities
Candidate MUST be located in Des Moines, IA

The Data Analytics Manager is responsible for oversight of Watson Healths Iowa Medicaid Enterprise Program Integrity Data Analytics team The Data Analytics Manager is responsible for designing and accurately completing a series of program integrity analytics used to identify and recover healthcare overpayments, identify managed care overpayment and underpayment issues, and benefit compliance issues The Data Analytics Manager may also support the development of analytics focused on analyzing the quality of care received by Iowa Medicaid beneficiaries

Essential Responsibilities Work closely with the client and project team to develop and implement an annual analytic work plan
Formally create, enhance and document policies and procedures as they relate to algorithm creation and completion
Consistently examine progress against plan and prioritize schedules, ensuring analytic deliverables are completed timely and annual fiscal goals are met or exceeded
Oversee the design, application, interpretation, documentation, and presentation of all comprehensive fraud, waste and abuse algorithms
Design, execute and present complex analysis as a member of the analytic team
Provide feedback and detailed review for all deliverables (algorithm programming, algorithm write-ups, letters, etc) to guarantee deliverables are reliable and completed accurately
Lead, supervise, train and coach internal analytic team with a customer-centered approach and attitude
Facilitate effective weekly/bi-weekly analytic team meetings
Address or delegate all ad-hoc data requests Monitor progress and present details and recommendations to allow committee to decide on next steps
Manage referrals to audit and investigation team and track provider case progress and needs
Document the potential return on investment and/or recoveries for the client based on data analysis efforts
Develop tools, reports and processes to effectively track cost avoidance
Build and maintain data scripts and tools to further automate Fraud and Abuse Detection System (FADS) processes
Participate in all relevant FADS meetings, such as audit committee meetings and management meetings
Function as a consultant for upgrading and utilizing the case management system and its reports
Serve as analytic resource and liaison between data management teams, project management, technical teams and analytic staff of proprietary systems
Coordinate support for FADS client users of proprietary systems, including training and fielding ad-hoc questions
Manage quarterly provider profile reports, identifying aberrant billers and peer group outliers
Work with leadership and sales staff to support future contract/business proposals
Assist in daily management tasks for entire FADS team, including personnel, staffing, technical, financial, goal-setting and other office-related issues
Stay abreast with modifications made to claims processing systems or data warehouses by working with contractors to understand problems and propose solutions
Work in partnership and support additional sub-contractors, ensuring they are performing consistently with contract expectations, and addressing any issues that may arise

Required Professional and Technical Expertise
Candidate MUST be located in Des Moines, IA
5 years of experience applying healthcare analysis methods and measures utilizing basic statistical methods
3 years managing/supervising staff
3 Prior experience with health care claims, provider relations, program integrity, fraud and abuse
Experience in data evaluation and database development
Experience managing in a fast-paced, goal-oriented environment
Experience developing policies, procedures, processes and workflows
Excellent oral and written communication skills
Demonstrated ability to convey complex ideas in an easily understood manner to aid audience through written or verbal communications
Demonstrated ability to understand industry issues and problems, relate them to clients needs, and propose appropriate solutions

Preferred Professional and Technical Expertise
MBA, JD OR MHA or Masters focused on healthcare or information technology (preferred)
Registered Health Information Administrator (RHIA certification), Certified Fraud Examiner (CFE) or Accredited Healthcare Fraud Investigator (AHFI) (preferred)
2-3 years State or Federal government experience either as employee or contractor
2-3 years auditing experience
Direct interaction with Medicaid or Medicare claims processing systems
Demonstrated ability to work closely and collaboratively with a client
Demonstrated project management, organization and prioritization skills
Experience using DataProbe and J-SURS
Experience using other analytic software such as SQL, Terradata, Cognos, Business Objects, Tableau, ArcGIS, SAS, SAS JMP, ACL, etc
Knowledge of ICD, CPT, HCPCS, NDC & DRG code sets

About Business Unit
IBM Watson Health is pioneering a new partnership between humanity and technology with the goal of transforming global health and revolutionizing many aspects of the medical and pharmaceutical industries, as well as government sectors We aspire to improve lives and give hope by delivering innovation to address the worlds most pressing health challenges through data and artificial intelligence insights

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Location Statement

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Profile Summary:

Employment Type : Full Time
Eligibility : Any Graduate
Industry : Software Services, IT-Software
Functional Area : IT Software : Software Products & Services
Role : Software Engineer
Salary : As per Industry Standards
Deadline : 13th Feb 2020

Key Skills:

Company Profile:

IBM India Pvt Ltdarfix

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