Informatics & Prepayment Review Health Consultant
A
Arizona Health Care Cost Containment SystemHealthcare
All work, including remote work, should be performed within Arizona unless an exception is properly authorized in advance.Full-TimeMiddle
Salary71,032 USD per year
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Job Details
- Experience
- 3 years of relevant healthcare experience.
- Required Skills
- Project ManagementData AnalysisMicrosoft AccessSharePointMicrosoft Excel
Requirements
- Current Arizona medical license (RN or higher) or Arizona Behavioral Health license (Associate or higher).
- Minimum of 3 years of relevant healthcare experience.
- Knowledge of Title XIX, Title XXI, Managed Care, Behavioral Health, and state/federal healthcare policies.
- Advanced skills in Microsoft Office (SharePoint, Excel, Access) and Google Suite.
- Demonstrated ability to perform data analysis, data management, and interpret utilization review regulations.
- Strong project management skills, including system implementation and process improvement.
- Excellent verbal and written communication skills for explaining complex data.
- Analytical ability to read, interpret, and apply complex rules and regulations.
- Organizational skills for setting priorities and managing workload.
- Valid Arizona Driver License may be required for travel-related duties.
Responsibilities
- Perform prepayment review of behavioral health documents and respond to claims disputes.
- Identify and report trends, issues, and outliers to management and oversight teams.
- Develop and maintain clinical data reports and presentations to synthesize findings and recommendations.
- Serve as the division subject matter expert for informatics, overseeing data analytics and Cognos reporting.
- Lead data analysis project management and process improvement initiatives.
- Provide education and technical assistance to internal and external stakeholders.
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