Jobs at J29, Inc.

Supports Independent Dispute Resolution and surprise billing appeals by coordinating case files, validating requests, analyzing medical and non-medical disputes, entering case data, communicating with appellants and providers, identifying potential fraud or abuse, and following CMS regulations and procedures.

Analyzes healthcare data using SAS, SQL, Excel, R, Python, Tableau, and related tools to identify trends, variances, outliers, and improvement opportunities. Creates reports, dashboards, tables, and visual presentations for technical and non-technical stakeholders. Supports healthcare intervention measurement, data entry, database functions, documentation, research, and policy compliance.

Analyzes healthcare data using statistical programming and data visualization tools to identify trends, outliers, quality improvement opportunities, and care indicators. Develops sampling and remeasurement strategies, benchmarks standards of care, prepares reports and manuscripts, creates healthcare interventions, and supports quality investigations. Mentors junior analysts, develops SQL code to join relational tables, and assists with associate onboarding.

Analyzes healthcare data using statistical methods, predictive modeling, machine learning, and visualization tools. Cleans and joins relational data, identifies trends and outliers, develops sampling and re-measurement strategies, builds predictive models, and prepares actionable reports for technical and non-technical stakeholders. Collaborates across departments, supports healthcare quality improvement, maintains data governance and regulatory compliance, and contributes to process and analytics capability improvements.

Supports core HR functions including onboarding and offboarding, employee relations, HRIS and personnel records administration, benefits coordination, compliance, recruiting support, employee communications, and HR process improvement. Advises employees and managers on HR policies, maintains confidentiality, supports audits, and ensures accurate employee lifecycle documentation and data.

Provides senior nursing expertise for healthcare program integrity initiatives, audits, investigations, claims and medical-record reviews, risk adjustment validation, fraud-waste-abuse prevention, and healthcare quality improvement. Analyzes clinical, operational, financial, encounter, enrollment, and prescription data; identifies compliance risks and vulnerabilities; develops recommendations and best practices; and collaborates with health plans, providers, government stakeholders, and cross-functional teams.

Reviews pharmacy and medical cases for overpayment, fraud, waste, and abuse; conducts desk and field audits; prepares case summaries, reporting, and clinical reviews; supports investigations, legal proceedings, training, and provider or beneficiary interviews. Serves as a pharmacist subject matter expert for program integrity, medical review, and data teams.

Provides expert guidance on pharmacy benefit management within the Department of Defense and TRICARE environment. Advises on benefit design, acquisition strategy, pricing, contracts, clinical pharmacy practices, compliance, and modernization. Bridges commercial pharmacy benefits practices with government and military healthcare requirements to reduce risk and improve outcomes for servicemembers and beneficiaries.

Lead the DHA HPIS program, overseeing daily operations, planning, resources, deliverables, risk, quality, reporting, compliance, and client communications. Manage and mentor Pharmacy SMEs and data analysts while coordinating with the Defense Health Agency. Drive strategic improvements, monitor contractual performance, manage budgets and subcontractors, and ensure successful delivery of analytics-driven pharmacy and healthcare program engagements.