Program Integrity Analyst III

🕒 Junho 16

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Qlarant

SiteLinkedInTodas as Vagas

501 - 1000 funcionários

Fundada em 1973

🏛️ Governo

⚕️ Seguro de Saúde

Government • Healthcare Insurance • Insurance & Financial Services

A Qlarant é uma empresa americana de serviços e tecnologia especializada em integridade de programas de saúde, oferecendo melhorias de qualidade, detecção de fraudes, desperdícios e abusos (FWA), serviços de investigação, além de ferramentas avançadas de análise de dados e modelos preditivos (a suíte de soluções de risco RIViR®) para agências governamentais, planos de saúde e setores relacionados. A empresa também opera iniciativas como a Fundação Qlarant e a Qlarant Capital para financiar subsídios e startups em estágio inicial, além de fornecer soluções focadas em farmácia, precificação de medicamentos e transporte.

Descrição

• Works with a team of internal and external professionals as a subject matter expert • Participates in planning and execution of team projects, assisting with setting strategic goals • Implements processes and uses necessary tools to enhance project execution and drive consistent performance improvements • Conducts research of program areas/topics defined by management; participates in internal and external focus groups • Utilizes experience to identify appropriate reports, rules, and regulations for drafting vulnerability reports • Meets regularly with teams to discuss current and future projects; advises teams and management • Contributes to final written product presented to stakeholders; proofreads written products of team members • Serves as a productive member of external and internal teams to ensure all deadlines for deliverables are met • Briefs management on projects, including completion timelines and potential difficulties • Provides clinical input as a Subject Matter Expert for program integrity and program vulnerability • Identifies and mitigates risks proactively, implementing strategies to ensure continuity of project execution • Participates in project reporting and performance analysis, ensuring accuracy of project data

🎯 Requisitos

• Bachelor's Degree required • 5 - 7 years required; 8 - 11 years preferred • RN preferred • Experience in Medicaid coding, billing, auditing, and compliance from a state or federal perspective • Medicaid program integrity auditing experience is preferred • Experience locating and interpreting publicly available Medicaid information to identify relevant potential program vulnerabilities