Sagility is a strategic business process management provider of transformative Healthcare solutions that help our clients significantly enhance the Member and Provider experience while providing for operational excellence to optimize the back office.
If you seek an opportunity to work with top clients around the world and be part of an enriching and nurturing work environment, check out this career opportunity with the Sagility Team!
We are currently hiring a talented Ideation Lead for our Payment Integrity Team. In this role you will create and implement an effective Outpatient audit program using program framework to develop rules to identify the claims for audit, create review guidelines and train the audit teams. The Ideation Lead also identifies and builds concepts by reviewing CMS guidelines, policies, and client specific criteria.
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.
� Develop analytics around concepts provided by internal or external sources with assistance from team members or direct supervision from development to production
� Review data requirements/design and implement logic to achieve data needs
� Implement and develop data concepts and monitor their impact
� Serves as a resource to operational claims and clinical staff, answering questions and assisting with department informatics, reporting and trending, and workflow/operational issues
� Provide executive level program updates and manage team escalations
� Comply with HIPAA Compliance and Security Policies and Procedures
� Facilitate innovation and continuous process improvement
Qualification
� Bachelor?s Degree ?
� Active CPC/COC certification
Required Skills and Experience:
� 5 years? experience in the health care industry (payer)
� Experience in performing medical records Review/ auditing claims
� 2 years? experience in outpatient coding
� Strong Outpatient Surgery and Observation Coding/Auditing experience
� Sound knowledge of ICD-10-PCS/CM, CPT and HCPCs Coding Guidelines
� Expertise with Medicare LCDs and NCDs
� Expertise with NCCI Guidelines, OPPS, APC
� Excellent verbal and written communication skills
� Experience with encoder tools (3M, Webstrat, Optum, Truecode)
� Maintains working knowledge of CMS rules and regulations and knowledge of procedure and diagnosis codes (CPT, ICD-9/10 coding, HCPCS and DRGs)
� Should be able to effectively coordinate with the development team and Stake Holders
� Must be a team player and adaptable to a dynamic work environment
� Proficiency in SQL/ PLSQL will be an added advantage
Sagility offers competitive benefits including:
� Medical
� Dental
� Vision
� Life Insurance
� Short-Term and Long-Term Disability
� Flexible Spending Account
� Life Assistance Program
� 401K with employer contribution
� PTO and Sick Time
� Tuition Reimbursement
Join our team, we look forward to talking with you!
Sagility is proud to be equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.