Job Title: Nurse Subject Matter Expert (Part-Time)
Post Date: 9/19/2023 – 10/31/2023

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 operational support position is for you.  The Nurse Subject Matter Expert provides nursing subject matter expertise (the art, practice, or profession of nursing (e.g., clinical operations, coding, and documentation)) on healthcare policies, programs, regulations, laws, products, services, and billing and payment methodologies in support of audits, data analysis projects, and program vulnerability studies. You will work as an integral member of a multi-disciplinary team in leading, developing, implementing, and executing audit and analytical approaches and strategies to make program improvements or solve problems in support of a contract. In this position, using your nursing and program integrity experience, the Nurse Subject Matter Expert will provide advice and input for conducting audits, reviews, studies, evaluations, and analytical projects.  The Research Analyst will receive all direction and instructions from a program manager or their designee for the work activities under the contract. 


Responsibilities

  • Provides clinical expertise to other functional areas (e.g., audits, complaints, data analysis, investigations, requests for information, predictive modeling, and vulnerabilities) in need of assistance and support.
  • Initiates and contributes to the conceptual design, methodologies, and implementation of projects, as well as assist with project execution as needed.
  • Develop solutions, alternative practices, or strategies to detect and prevent fraud, waste, and abuse.
  • Gather and organize information about a problem to be solved or the procedure or process to be improved.
  • Analyze medical, operational, and performance data; information; and other forms of evidence.
  • Participate in audit activities, such as performing audits and/or reviews of healthcare services based on billing and medical records, compendia, and criteria to evaluate the appropriateness of the patient encounters.
  • Interact and confer with team members on a variety of topics, such as ideas, projects, approaches, methodologies, and strategies, using all forms of available communications.
  • Review and analyze encounter data, fee-for-service claims, enrollment data, prescription drug event records, and other data sources in providing advice, input, and recommendations.
  • Interpret Medicare and Medicaid policies, laws, rules, regulations, manuals, and healthcare industry guidelines in conducting audit, analytical, and program vulnerability study activities.
  • Serve as a technical resource in clinical operations, practices, and data and information; medical record documentation; healthcare trends, patterns, and anomalies; inpatient and outpatient codes (e.g., Current Procedural Terminology (CPT), Diagnosis Related Group, and Healthcare Common Procedure Coding System (HCPCS) Codes); and International Classification of Diseases Codes.


​​​Qualifications

  • The position requires a bachelor of science in nursing degree programs, like programs in some other healthcare and related fields, typically taking 4 years to complete. All programs must have included supervised clinical experience. A minimum of 10 years of experience in practice (clinical, claims processing, health systems, consulting, industry or academia).  Prefer a license to practice nursing in a state, District of Columbia, or a territory of the United States.
  • Preference is given to candidates with a strong knowledge of clinical operations, coding, and medical record documentation requirements.
  • The nature of the work requires a minimum of 8 years of experience supporting government and private program integrity operations. Experience working for a health plan, regulatory government agency, special investigation unit, and program integrity contractor is preferred.
  • Must possess substantial familiarity with federal healthcare programs, such as Medicare and Medicaid, and the governing laws, rules, regulations, and policies. Preference is given to candidates with outstanding organizational, time management, and interpersonal skills; superior technical writing and research ability; and a demonstrated commitment to professionalism and ethics.

 
Skills

  • Requires experience with health plan, provider, and supplier operations.
  • 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
No travel is required.


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

Apply Now
Email Resume To: jarias@aridell.com​​​


Aridell Associates, LLC

Current Job Opportunities

​Serving tHE Healthcare,

Financial, Insurance, and Public SectorS

Job Title: Research Analyst (Part-Time)
Post Date: 9/19/2023 – 10/31/2023

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 operational support position is for you.  The Research Analyst serves as an integral member of a multi-disciplinary team in conducting program vulnerability activities in support of a contract. In this position, you will support program vulnerability projects, such as conducting research, identifying vulnerabilities, scoring risks, and reporting results. The Research Analyst will receive all direction and instructions from a program manager or their designee for the work activities under the contract. 


Responsibilities

  • Assist the team with identifying, triaging, and prioritizing existing and emerging vulnerabilities in federal healthcare programs, providing guidance and support for vulnerability mitigation, and evaluating the success and impact of the mitigation strategies and completed actions in order to close vulnerabilities.
  • Use environmental scanning techniques to identify vulnerabilities.
  • Support the team in assessing the risk of each identified vulnerability by developing and preparing written risk assessments on different client programs and areas. 
  • Develop risk mitigation approaches and solutions, alternative practices, or strategies to prevent fraud, waste, and abuse.
  • Research and analyze financial, operational, and performance data, information, and other forms of evidence.
  • Prepare reports containing summaries of vulnerabilities and associated recommendations for submission to the client’s management.
  • Interpret CHIP, FFE, Medicaid, Medicare, and value-based payment programs policies, laws, rules, regulations, manuals, and healthcare industry guidelines in conducting program vulnerability study activities.
  • Educate and explain healthcare payment models, coding practices, and the coding process to clients and team members as needed.
  • Communicate responses during face-to-face and virtual meetings with the client and team members to address inquiries, and other client partners and stakeholders.


Qualifications

  • The position requires a bachelor’s degree with preference given to those degrees in a business administration, public policy, or public administration relevant field.
  • At least two years of experience required in Marketplace, Medicare, Medicaid, and CHIP programs with an expert level of understanding of the associated regulations.
  • Experience working for a health plan or an oversight/regulatory government agency is preferred.​

 
Skills

  • Requires 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
No travel is required.


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

Apply Now
Email Resume To: jarias@aridell.com​​​