​Serving tHE Healthcare,

Financial, Insurance, and Public SectorS

Current Job Opportunities

Job Title: Medicare Part C and Part D Subject Matter Expert (SME)
Post Date: 07/26/2018 – 08/24/2018

Position Summary
Aridell Associates, LLC, a professional consulting firm, advises clients on healthcare program operations and helps clients develop solutions to maximize meaningful outcomes, improve their operations, and protect their valuable assets, as well as bestow customer confidence in their operations.  Our mission is to advance clients’ operational performance and provide sustainable long-term, successful business strategies.

If you are interested in providing consulting and advisory services or supporting contracts, then this position is for you.  The Medicare Part C and Part D SME works as an integral member of a multi-disciplinary team in supporting contracts and clients on health plan operational and government program matters. In this position, you will serve as a subject matter expert in analyzing healthcare claims and encounter data, answering healthcare coding and clinical questions, identifying coding disconnects, and explaining the coding of procedures and services.

Responsibilities

  • Research and answer healthcare coding questions posed by clients and team members.
  • Interpret policies, laws, rules, regulations, and healthcare industry guidelines (e.g., NCDs, LCDs, drug compendia).
  • Support audits, data analysis projects, operational plans, and statistical sampling designs.
  • Educate and explain healthcare payment models (e.g., risk adjustment payment models), coding practices, and the coding process to clients and team members as needed.
  • Prepare standard and ad hoc deliverables for clients.
  • Verify and validate healthcare procedure and service codes when requested.

  • Provide subject matter expertise on Medicare Part C and Part D, Medicaid, and other government healthcare programs’ operations.
  • Communicate responses during virtual meetings with the client and team members to address inquiries.
  • Serve as a technical resource in coding and reimbursement systems.
  • Maintain a detailed level of knowledge of Medicare and Medicaid coding guidelines, other payer rules, and ICD-9, ICD-10, HCC, RxHCC, CPT, DRG, HCPCS, and NDC coding.


Qualifications

  • Requires a postgraduate degree in a healthcare related field.
  • Requires a minimum of 3 years of experience in a clinical or healthcare administration setting.
  • Requires a minimum of 10 years of professional experience with a minimum of 5 years of first-hand experience with government healthcare programs.
  • Doctor of Pharmacy preferred.


 Skills

  • Medicare Part C and Part D Subject Matter Expert shall be able to demonstrate knowledge and a thorough understanding of the following:

            - Medicare Part A, Part B, Part C, and Part D programs.

            - Medicaid programs.

            - Health plan, prescriber, provider, pharmacy, pharmacy benefit manager (PBMs), and supplier operations.

            - Healthcare delivery, billing, and coding processes.

            - Federal and state healthcare programs’ operations, regulations, manuals, and processes.

  • Requires experience in training and educating professionals about healthcare delivery and prescription drug industry practices.
  • Experience with a variety of electronic health records is preferred.
  • Ability to work under pressure and short deadlines.
  • Requires excellent professional presentation skills.
  • Strong organizational, planning and prioritization skills with the ability to collaborate with others and multi-task.
  • Ability to analyze data and conduct research to draw conclusions and provide solutions.
  • Thorough understanding of billing forms, Remittance Advices, Explanations of Benefits and provider billing statements.
  • Excellent written and verbal communication skills.
  • Ability to present to large or small groups when required.
  • Solid computer proficiency with the Microsoft Office Professional Suite, including Word, Excel, Access, PowerPoint, and Outlook.


Travel Requirements
Minimal travel is required. 

Job Location
This is a work-from-home/remote position.

Apply Now
Email Resume To:jarias@aridell.com

Job Title: Law Enforcement Liaison
Post Date: 07/26/2018 – 08/24/2018

Position Summary
Aridell Associates, LLC, a professional consulting firm, advises clients on healthcare program operations and helps clients develop solutions to maximize meaningful outcomes, improve their operations, and protect their valuable assets, as well as bestow customer confidence in their operations.  Our mission is to advance clients’ operational performance and provide sustainable long-term, successful business strategies.

If you are interested in providing consulting and advisory services or supporting contracts, then this position is for you.  The Law Enforcement Liaison works as an integral member of a multi-disciplinary team in conducting education and outreach activities in support of a contract. In this position, you will educate law enforcement and others on the Medicare Part C and Part D programs and program integrity matters. The law enforcement liaison will receive all direction and instructions from a program manager or their designee for the work activities under the contract. 

Responsibilities

  • Interacts with law enforcement and other regulatory agencies.
  • Under minimal supervision, maintains a working knowledge of partners' and stakeholders' needs, deliverables, and resources.
  • Contributes to improving operations and work flow efficiencies.
  • Responds to partners' and stakeholders' needs for information and clarification.
  • Uses positive interpersonal skills in conducting all work.
  • Develops and delivers presentations.
  • May conduct or support education and training.
  • Prepares standard and ad hoc deliverables for clients.


Qualifications

  • ​A bachelor’s degree in criminal justice or a related field is required.
  • At least 5 years of law enforcement experience is preferred.
  • Requires a minimum of 10 years of professional experience with a minimum of 5 years of first-hand experience with government healthcare programs.
  • Must have a working knowledge of Medicare laws, rules, and regulations.


Skills

  • Requires experience in training and educating professionals about healthcare and prescription drug industry practices, including fraud, waste, and abuse schemes.
  • Shall be able to demonstrate knowledge and a thorough understanding of the Medicare Part A, Part B, Part C, and Part D, and Medicaid programs.
  • Requires experience with health plan, prescriber, provider, pharmacy, pharmacy benefit manager (PBMs), and supplier operations.
  • Experience with healthcare claims and billing processes.
  • Knowledge of federal and state healthcare programs’ operations, regulations, manuals, and processes.
  • Ability to work under pressure and short deadlines.
  • Requires excellent professional presentation skills.
  • Strong organizational, planning and prioritization skills with the ability to collaborate with others and multi-task.
  • Excellent written and verbal communication skills.
  • Ability to present to large or small groups when required.
  • Proficient in using the Microsoft Office Professional Suite, including Word, Excel, PowerPoint, and Outlook.


Travel Requirements
Twenty-five percent travel is required. 

Job Location
This is a work-from-home/remote position.

Apply Now
Email Resume To: jarias@aridell.com

Aridell Associates, LLC