Must Be a US Citizen or Greencard Holder
Should be a graduate or the relevant one
Initially remote due to Covid-19 situation then onsite
Financial Healthcare experience
Contract analysis, claims pricing and value-based reimbursement
Pricing, editing and mapping for Federal (DRG, APC, ASC, etc.)
Relational database concepts, SQL based data extraction, querying and scripting
Data gathering and presentation techniques;
Data warehouses/data stores and data marts;
HIPAA and organization/department level security policies and procedures;
Managed Care operation concepts and principles;
Business system applications used in customer departments;
Complex information systems applications;
Departmental information processing environment, systems technology and networks;
Application development lifecycle and flowcharting techniques;
Systems troubleshooting techniques and program design;
Structured analysis and database concepts;
Principles and methods of systems and procedures;
Principles and practices of technical problem solving;
Methods for protecting security and confidentiality of system data;
Principles and practices of producing project and technical documentation;
Project management at a basic level, including organizing and managing a project schedule.
Advanced analytics and statistical models to identify trends, patterns, and relationships
Scope of Work: A more detailed scope of work may be further defined with the Consultant but the preliminary scope is as follows:
The Consultant is responsible for the technical delivery of two separate implementation projects:
1. NetworX/QNXT Integration: Consultant will serve as a technical lead on the NetworX/QNXT Integration, involved with the configuration, integration, testing and reporting activities necessaryfor implementation. The Consultant will be responsible for the following:
a. Developing metrics for business outcome tracking and obtaining baseline measurements.
b. Work with the business units to obtain the functional/technical requirements
c. Prepare inventory of interfaces and extracts required for the implementation software and ensures manual and programmatic loading/import of contracts, code groups, schedules and claims.
d. Develops technical documentation and reviews pertinent vendor design docs and specifications.
e. Define test strategy for integration testing, and work with the business through UAT to define key areas of validation and subsequently deployment to production.
2. Data Warehouse Build: Consultant will serve as a database architect responsible for the design, creation and implementation of a healthcare data warehouse.
a. Integrating, preparing and analysing large, varied datasets, and developing and applying algorithms and models on the data to reveal insights.
b. Delivering a technical architecture and design documents for the data warehouse
c. Working with the business to apply and document business rules d. Delivering defined format of the data warehouse, data marts and
identification/development of front end BI tools
e. Defines test strategy for the implementation of a data warehouse
f. Defines processes to maintain frequency of uploads and processes to ensure data quality and subsequently deployment to production.
Provides technical advice and recommendations regarding the creation or modifications of policies, procedures, enhancements
Make strategic recommendations on the design and approach for complex data analytics projects
Uses progressive utilities (i.e. MS SQL Server Databases, SSRS, and SSIS) to execute and troubleshoot production reports and scheduled data extraction events.
Creates data visualization and reports using presentation layer tools (i.e. KPI, dashboards)
Extracts and manages multiple sets of data from various databases and sources, bringing together data from several channels for comparative analysis
Mines and analyzes data using statistical tools and techniques
Maintain understanding of managed care industry guidelines/mandates and ensure technical/system and process compliance.
Participate in project and team status meetings relative to duties.
Works with senior leadership as an executive advisor and to determine data analytic organizational goals
Provides expertise in determining the right type of analytics or statistics to apply to data sets collected and utilized by the customer.
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