Job Code : GEN/1212
Work@HomeJob Description
About Sagility
Sagility is a tech-enabled BPM services provider, a thought partner providing a broad spectrum of transformational services, to enable our clients provide efficient and hi-quality care across the healthcare system.
Sagility?? combines industry-leading technology and transformation-driven BPM services with decades of healthcare domain expertise to help clients draw closer to their members. We optimize the entire member/patient experience through service offerings for clinical, case management, member engagement, provider solutions, payment integrity, claims cost containment, and analytics.
Leading industry analyst firms have consistently cited our service excellence, breadth of offerings, and ability to execute. The most recent being recognized as a leader for Healthcare Payer Operations in 2022 as a part The Healthcare Payer Operations PEAK Matrix� Assessment report by Everest Group. To learn more about our recognitions please visit our AWARDS SECTION
We have 28,000 employees in 15 cities across 5 countries ? India, Philippines, USA, Jamaica, and Colombia.
This role is to build and implement an effective data mining program. This position is responsible for data collection, data analytics and data reporting for Data Mining programs including but not limited to COB, Duplicate, Contractual, billing errors, overlapping services etc.
Key Responsibilities
? Identify new concepts which have the savings potential for development and deployment.
? Drive specific measurable results with timely deployment of concepts
? Work with audit leaders and establish a process to ensure the concepts being deployed are working as expected with higher findings thus ensuring higher hit rates and findings rates on the concepts deployed.
? Ensure to create review guidelines for concepts deployed to ensure operations and audit staff have all the information they need to work the concepts.
? Continually identify and deploy new edits and algorithms to drive incremental savings
? Establish strong relationships with internal and external stakeholders to define, align and delivery payment accuracy initiatives
? Influence leadership to adopt new ideas, and products as an experienced industry leader.
? Provide executive level program updates and manage team escalations
? Operate as an industry thought leader in Payment Integrity
? Comply with HIPAA Compliance and Security Policies and Procedures
? Facilitate innovation and continuous process improvement
Qualification
? Bachelor?s Degree
Required Skills and Experience:
? 5 years? experience in the health care payer industry (Medicare, Medicaid, and/or Commercial)
? 2 years? experience in Data Mining ideation and research of new concept development
? Maintains working knowledge of CMS transmittals, RAC and OIG reports
? Proficiency in SQL/ PLSQL and MS Office products
An ideal candidate should be:
? Keep abreast of industry trends and opportunities and apply best practice to payment integrity
? Ability to think analytically, apply analytical techniques and to provide in-depth analysis
? Love collaborative environments that use agile methodologies to encourage creative design thinking and find innovative ways to develop with cutting edge technologies
? Proven interpersonal skills while contributing to team effort by accomplishing related results as needed
? Must be a team player and adaptable to a dynamic work environment
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