Consultant

• Focus on AI to streamline processes and design solutions to prevent FWA and over-payment
• Undertake complex assignments requiring specialized technical knowledge
• Conduct extensive research on CMS regulations, internal/external reimbursement, and medical/clinical policies, supporting findings with official documents
• Establish and communicate common goals and direction for the team
• Establish and maintain advanced knowledge of data warehouse database design, data definitions, system capabilities, and data integrity issues
• Act as a source of direction, training and guidance for less experienced staff
• Analyze pertinent claims and medical records and present findings
• Develop and support very complex Data Warehouse-related applications for business areas, including design and implementation of database tables
• Conduct training on the use of applications developed
• Maintain current industry knowledge of claim edit references, including AMA, CMS, and NCCI

Medical Claims Data Integrity Consultant

Portfolio Support Consultant

IT Portfolio Consultant

Platform Consultant

Workday AMS Advanced Compensation Lead Consultant

Loan Review Consultant