Job Description :
Job Details:
Job Title: Sr.Data Coach
Location: Columbia, MD
Duration: 6+ months

Job Description

Provide on-going healthcare fraud, waste and abuse data, tool and analytics support for users when directed by the team and customer.
Support the help desk in responding to technical and data questions that are received from end users.
Build and maintain positive, productive relationships with colleagues, managers, partners, customer, and users to foster collaboration and consensus.
Champion the needs of the users and provide recommendations for improving the system capabilities and performance to enhance the value for end users.
Identify and recommend policy, procedure, and system changes to enhance investigative outcomes and performance.
Conduct data mining, analysis, and reporting using available tools and data sources.
Prepare and present live and online subject matter topics to team, customer and end users, and possibly at conferences and tradeshows.
Work closely with the team to draft and execute an effective end user support and training strategy.
Assist in the creation and development of various training materials, including trainer guides, training video or audio, instructor/participant materials, interactive online courseware, and evaluation systems.
Support local, offsite and online train-the trainer and end-user training classes with subject matter expertise.
Interact frequently and professionally with the customer and stakeholders in a variety of settings including meetings, teleconferences, and written communications.
Identify areas for improvement and make recommendations to increase the quality and effectiveness of support and training processes and materials based on user feedback and industry best practices.
Stay abreast of industry trends to proactively identify opportunities for fraud or emergent schemes.
Maintain and report on various project metrics as required.
Required Skills & Experience
Bachelor''s degree in healthcare or business administration, information technology, public health, or related fields.
Must have recent experience with Medicare and/or Medicaid Part A, B, & DME claims, coding, and reimbursement procedures, service and coverage policies, coordination of benefits, as well as provider and beneficiary eligibility.
Demonstrated performance with high volume data analysis and business intelligence tools such as BusinessObjects, SAS Enterprise Guide, MicroStrategy, Cognos, etc…
Thorough understanding of claims and healthcare terminology and codes as published by CPT, ICD, HCPCS, and DRG manuals.
Excellent analytical and problem-solving skills, with the ability to integrate information from multiple sources to execute effectively and efficiently in a dynamic environment.
Ability to meet time-sensitive and mission-critical deadlines with minimal supervision
Able to translate, articulate, simplify and communicate complex business and technical functions to audiences with different level of expertise.
Superior communication and organization skills are a must with ability to handle multiple tasks in a fast paced work environment and thrive in an environment with regularly changing priorities.
Confident and results-driven self-starter skilled in taking initiative, assessing requirements, coming up with plans, and taking the lead in making plans reality.
Desired Skills & Experience
Past experience as a Zone Program Integrity Contractor (ZPIC), Program Safeguard Contractor (PSC), Medicare Drug Integrity Contractor (MEDIC), Medicare Administrative Contractor (MAC), or Recovery Audit Contractor (RAC) is highly desirable.
Familiarity with the Centers of Medicare and Medicaid Services (CMS) Integrated Data Repository (IDR), One Program Integrity (One PI), Shared Systems, and/or Common Working File (CFW), and other fraud detection and prevention solutions.
Certified Fraud Examiner (CFE) or Accredited Health Care Fraud Investigator (AHFI) a plus.
Thorough understanding of Part D Prescription Drug Event (PDE) and Part C encounter data
Experience with state Medicaid claims and systems such as Medicaid Management Information System (MMIS) or Medicaid and Statistical Information System (MSIS
Nursing or clinical experience is desired.
Certified Professional Coder-CPC or CCS preferred.
Experience as a trainer in a classroom setting.
Experience with statistical data analysis techniques such as modeling, aggregation, trending, patterns, random sampling, and ratios to identify outliers.