DESCRIPTION:
- Healthcare Background | Plan & Policy Understanding | Medicare Program | STAR Rating | Medicare Revenue - P&L
- Understanding of Claims | Encounters – Process and Data Understanding
- Understanding of Risk adjustments | Provider Network
- Expectation is the candidate should have all the domain knowledge to hit the ground running from da
- Strong Analytical Skills
- Visualization Exp (Tableau)
- Candidate will have client level of interview, Expectations
- Hire someone from Optum, Signa or similar health insurance company
Projects
Provider Performance Dashboard – Understand and monitor the provider care management program and identify good performers and under performers
Medicare - Risk Management & identify other opportunities by understanding the Revenue structure for members with and without chronic disease
Skills:
- Healthcare Background SME
- Plan & Policy Understanding
- Medicare Program
- STAR Rating
- Medicare Revenue - P&L
- Strong Analytical Skills
- Tableau
- SQL