Specialist, Complex Clinical Solutions

AMS (Advanced Medical Strategies)

1d•$115,000 - $130,000

About The Position

Reporting to the VP of Complex Clinical Solutions, you will be part of a team responsible for supporting the payment integrity experience for clients utilizing AMS software. The role involves client support, analyzing client data, and ensuring accuracy of technical and clinical information for itemized bill review. It’s a collaborative role that’s pivotal to multiple internal teams as well as external clients.

Requirements

Demonstrate analytical, critical thinking, complex problem solving and decision-making skills
Strong time management skills while producing accurate work; ability to adjust priorities as required to accomplish departmental objectives
Ability to multi-task and adapt promptly to change
Self-directed with the capability of working both independently and as part of a team; strong team and collaborative skills
Excellent verbal and written communication skills
Strong technology and computer proficiencies including MS Office Suite expertise
Insight into software data security and privacy assessments, audit and risk management/mitigation practices, and information security standards
Familiarity with (or ability to become familiar with) information security regulations, data protection laws, and auditing frameworks such as HITRUST and HIPAA.
Active and unrestricted nursing license
Minimum bachelor's degree in nursing
4+ years experience as a nurse in a clinical setting
2+ years experience working in payment integrity industry with an emphasis on itemized bill review

Nice To Haves

Master’s degree in a related field (such as Nursing, Healthcare Administration, etc.)
Experience working with healthcare data analytics

Responsibilities

Provide education and clinical expertise to AMS and clients for the itemized bill review process. Internally, support staff with your knowledge of the payment integrity industry.
Support sales and client relations with content preparation, by speaking at industry venues, and by demonstrating the benefits of itemized bill review software products during client-facing presentations.
Review policy verbiage to provide feedback to clients, enhance usage of products, and create internal policies related to itemized bill review.
Collaborate with IT on enhancements to product features, functionality, and user interface.
Utilize your medical knowledge along with internal resources, professional resources, clinical practice guidelines, and subscriber policies to create product content.
Perform quality assurance for software development and to ensure positive client outcomes.
Utilize your critical thinking abilities to collect, analyze, and evaluate information for additions and changes to the product database.
Collaborate and communicate with external clients as well as internal departments such as IT, Client Relations, and Sales to facilitate the design and acceptance of itemized bill review products.
Engage in projects that support departmental goals and identify new opportunities for growth and enhancement.
Promote a safe and healthy work environment by adhering to organization standards and legal regulations.