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Provide subject matter expertise related to Medicare Fee-for-Service payment policies, billing process, documentation requirements, and medical necessity requirements
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Provide subject matter expertise related to Medicare Fee-for-Service program integrity operations, including improper payment rate measurement, auditing, payment recoveries, and provider education
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Research current Medicare payment policies and track changes to policies pertaining to selected topics in Medicare Fee-for-Service
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Conduct analyses and manage analytical teams, including queries and summaries of Medicare claims data, review data, and program integrity operations data, to identify areas of improper payment, root causes, and program integrity activities to address improper payment
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Assemble government-facing reports regarding improper payment drivers, policy trends, and effectiveness of program integrity operations, including recommendations regarding program integrity strategies
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Communicate findings with CMS stakeholders, including divisions of the Center for Program Integrity and Office of Financial Management
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Bachelor's degree in an analytical or policy-related field, including economics, government, statistics, mathematics, computer science, or other relevant coursework
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8+ years experience related to healthcare operations, such as federal or private healthcare consulting
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4+ years experience analytical work related to Medicare or Medicaid, including analysis of claims data in the IDR
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2+ years experience managing analytical teams
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General knowledge of Medicare Fee-for-Service payment policies, billing process, documentation requirements, and medical necessity requirements, spanning Part A inpatient services and post-acute care services, Part B outpatient and physician services, and Durable Medical Equipment
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General knowledge of Medicare program integrity operations, including MAC auditing, recoupment, and provider education
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Experience constructing federal-facing reports and presentations, and communicating with administrators of federal programs including Medicare or Medicaid
Skills Required
- Bachelor's degree in an analytical or policy-related field such as economics, government, statistics, mathematics, computer science, or equivalent relevant coursework
- 8+ years of experience related to healthcare operations, including federal or private healthcare consulting
- 4+ years of analytical experience related to Medicare or Medicaid, including claims data analysis in the IDR
- 2+ years of experience managing analytical teams
- General knowledge of Medicare Fee-for-Service payment policies, billing processes, documentation requirements, and medical necessity requirements across Part A, Part B, and Durable Medical Equipment
- General knowledge of Medicare program integrity operations, including MAC auditing, recoupment, and provider education
- Experience constructing federal-facing reports and presentations and communicating with federal program administrators
What We Do
ePATHUSA was founded in 2005 as a global software consulting and outsourcing company of the highest standard. Always reliable, we provide strategic counsel and managed services to federal, state, commercial, and nonprofit entities. The always accelerating change in technology challenges companions to adapt - requiring constant modernization to maintain relevance. We proudly help organizations do just that. Our diverse, expertly skilled team assesses and implements cutting-edge technologies most beneficial to achieve client’s needs and goals.
