Req ID: 57452BR
The Fraud Analytics team is looking for an Informatics Clinical Consultant skilled in utilizing healthcare claims data; the ideal candidate retrieves, organizes and performs analysis on healthcare data to identify outliers or aberrancies. This role also supports the team in development, validation and deployment of business rules indicative of fraud, waste or abuse (FWA) or payment integrity. This position requires knowledge of healthcare claims and will work on identifying opportunities and delivering clinical/coding insights.
+ Consults and lends clinical expertise to internal clients and colleagues
+ Consults with internal clients to identify opportunities to implement data science solutions for business problems
+ Ability to structure data analysis, driving analytics insights and analytical solutions to help the internal team develop simple to complex business rules
+ Validation and deployment of algorithms or business rules developed to identify outlier billing patterns within claims data that may be indicative of FWA or payment errors
+ Provide clear and concise feedback on any coding changes that are required
+ Keep current with new & emerging fraud, waste and abuse schemes and trends through training sessions and industry resources
+ Interprets, analyzes and presents key findings to internal team or business partners
+ Providing recommendations based on analytical findings
+ Collaborates with business partners to understand their strategy, problems, and goals
+ Minimum 2-5 years experience in FWA or Payment Integrity
+ 2+ years experience in clinical coding or consulting
+ Experience in use of business tools to query large datasets, e.g., Netezza, SAS Enterprise Guide
+ Demonstrates strong ability to communicate new concepts and implications to business partners
+ Certified Professional Coder preferred
The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.
ADDITIONAL JOB INFORMATION
Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come.
We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence.
Together we will empower people to live healthier lives.
Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities.
We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.
Benefit eligibility may vary by position. Click here to review the benefits associated with this position.
Aetna takes our candidates's data privacy seriously. At no time will any Aetna recruiter or employee request any financial or personal information (Social Security Number, Credit card information for direct deposit, etc.) from you via e-mail. Any requests for information will be discussed prior and will be conducted through a secure website provided by the recruiter. Should you be asked for such information, please notify us immediately.
Job Function: Health Care
Aetna is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected Veterans status.
Associated topics: accounts receivable, bill, biller, cbo, clinical documentation specialist, coder, data entry, medical coder, medical coding, transcription medical