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Post Payment Analytics – Ppa – Subject Matter Expert – SME
| Company | Trilogy Federal |
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| Location | Washington, DC, USA |
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| Salary | $120000 – $145000 |
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| Type | Full-Time |
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| Degrees | Master’s |
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| Experience Level | Expert or higher |
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Requirements
- Master’s degree
- At least 10 years’ experience implementing programs and supporting progressive analytics in a large organization (Federal agencies and/or private corporate firms)
- VHA experience.
- Extensive knowledge regarding industry standard billing practices, particularly Medicare
- Extensive knowledge understanding and assessing the use of CPT, HCPCS, ICD and other relevant billing codes, to include modifiers.
- Extensive knowledge of Medicare IPPS, OPPS and all associated policies and edits
- Knowledge of valued based care principles and concepts
- Knowledge of CAQH Core
- The ability to obtain a Public Trust Clearance.
- Excellent written and verbal communications skills
- The ability to support ad hoc travel, per customer requirements
- Successful engagement with organizational senior leadership
Responsibilities
- Support the development of highly complex family member program reports and deliverables and other supporting activities related to PPA dashboard administration and maintenance.
- Perform analysis on payment data that leads to improved revenue cycle efficiency.
- Perform data mining and query development activity to uncover improper payments that may come as a result of billing error, fraud, waste and abuse.
- Evaluate claim data to identify trends and optimize financial performance.
- Execute data collection, analysis, reporting, and collaboration with other stakeholders to address payment issues.
- Ad hoc and other strategic support tasks, as assigned by client and project manager.
Preferred Qualifications
- Prior experience working in a healthcare organization (e.g., hospital, health system, health insurance company, military health etc.)
