Research analyst job description

The Program Integrity Coding & Research Analyst acts as a Medical Coding subject matter expert for complex coding concerns and serve as primary coding resource for Program Integrity (PI). This position is full-time remote.
Essential Functions:
Use concepts and knowledge of CPT, ICD10, HCPCS, DRG, REV coding rules to analyze complex provider claims submissions Take a lead role to determine root cause of provider claim issues and resolve by analyzing system configuration, payment policy, and claims data Research, comprehend and interpret various state specific Medicaid, federal Medicare, and ACA/Exchange laws, rules and guidelines Maintain knowledge and stay current with Federal and State Regulatory requirements, i.e. CMS and ODJFS as well as coding guidelines, federal laws, rules, and billing guidelines for various provider specialty types and lines of business Prepare and respond to legal activities which includes discovery and trial preparation and testifying as needed Identify audit payment integrity issues for PI investigations, audits, provider pre-pay, etc.Assist in the development and implementation of an annual audit plan for providers with high risk for fraud using appropriate risk based methodology Provide critical research and analysis of functional performance, and make recommendations for enhancements, cost savings initiatives and process improvements Prepare and monitor various management and oversight metrics & reports as required Manage quality audits of our internal coding validation analysts and produce monthly reports for the manager.Recognize inconsistencies and gaps in Program Integrity business processes and work collaboratively to resolve the identified issues Generate comprehensive, clear, concise, and in-depth reporting and analysis and provide recommendations based on findings Provide support to the claims pre-pay team to analyze and identify trends in claims Manage the entry and tracking of system change requests, via appropriate ticketing system, for configuration or other Program Integrity improvements; act as primary resource and SME in corporate meetings and projects Identify payment integrity issues with claims reimbursement methodologies Analyze and report financial savings related to process improvements Build strong working relationships with Markets and departments that are essential for resolving systemic issues and driving process improvements Perform any other job related instructions as requested

Education and Experience:
Bachelor's degree in Business Administration or related field or equivalent years of relevant work experience is requiredA minimum of five (5) years of experience in medical coding, to include experience in program integrity coding audit, is required Experience with reimbursement methodology (APC, DRG, OPPS) is required

Competencies, Knowledge and Skills:
Proficient in Microsoft Office toolset Proven ability to establish effective working relationships with stakeholders at all different levels Excellent written and verbal communication skills Effective identification of business problems, assessment of proposed solutions to those problems, and understanding of the needs of stakeholders Ability to work independently and within a team environment Ability to multi-task and prioritize work to meet project deadlines Effective listening and critical thinking skills Flexibility during organizational and/or business changes Strong interpersonal and relationship building skills Effective problem solving skills with attention to detail Ability to effectively and efficiently work within a project team Time management skills Customer service oriented Decision making/problem solving skills Ability to develop, prioritize and accomplish goals Ability to coordinate and lead cross-functional teams

Licensure and Certification:
Certified Professional Coder (CPC) or equivalent billing/coding designation is required

Working Conditions:
General office environment; may be required to sit or stand for extended periods of time

Organization Level Competencies
Leveraging FeedbackCustomer OrientationValuing DifferencesManaging WorkEarning TrustQuality OrientationAdaptabilityInfluencingCollaborating

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer, including disability and veteran status. We are committed to a diverse and inclusive work environment.

Job DescriptionWHAT YOU'LL DOAs a Research Analyst within BCG's Data & Research Services (DRS) team, you will provide secondary research in support of proposals, client cases, and business or IP development initiatives within our Health Care practice, focusing on a range of biopharma R&D, manufacturing, and commercial topics. You will be responsible for delivering on variety of requests through the day.

The environment is fast paced and may need you to connect with the customers from the consulting and knowledge teams to refine/understand the scope, devise an appropriate approach; package and deliver to the satisfaction of the customer. There is opportunity for you to grow and learn in an apprenticeship culture where you can quickly build and expand your research knowledge base to the next level.

Although primarily focused on Health Care Biopharma sector research you will support and contribute to research efforts in other Health Care topics (Payer & Provider, and MedTech) from time to time as needed.

This role is a Secondary Research position, not clinical or lab based. YOU'RE GOOD ATDeveloping topic knowledge and industry expertise

You will manage various research requests with a high-level accuracy and organization within the Health Care Practice, primarily focused on biopharma-related topics.

You will be required to understand request objectives focused on biopharma topics, and proactively suggest most appropriate and efficient research approach to senior DRS team members and customers, as appropriate

You will evaluate our source quality and data accuracy, and proactively help to identify and raise research-related issues
Customer and team orientation
You will engage in thought partnership with consulting teams and knowledge teams to understand, scope and deliver accurate, timely and relevant data and information You will be coaching Research Associates and outsourcing partners, as well as delivering data quality analysis with them
Utilization and development of tools and technology
Along with collecting, summarizing, and synthesizing relevant data and information into appropriate, concise, timely and highly effective output, you are proficient in Excel, Word, and PowerPoint With guidance, you will develop tools, resources, and trainings within Health Care, you will be contributing to knowledge capture and documentation Using your strong analytical thinking, you will provide advanced synthesis, and develop deep expertise in specialized research tools, databases and sources
Working flexibly in in a fast-paced environment
In addition to being intellectually curious and being able to work in a fast-paced, deadline focused environment, you can identify practical, timely and innovative research approaches
YOU BRING (EXPERIENCE & QUALIFICATIONS)
2-4+ years relevant working experience, with some specialization in one or more of: health care, pharmaceuticals, biotech, or other related field. You will have a strong interest in specializing in Biopharma topics in relation to Business Strategy, such as (but not limited to) Company’s products portfolio analysis, pricing and access trends, generic erosion, Biopharma market landscaping, Launch strategies for new drugs. Bachelor’s degree required Proficiency in Excel and PowerPoint Excellent English written and oral communication
YOU'LL WORK WITHOur knowledge and research specialists collaborate with global colleagues across BCG to bring expertise and capabilities to the service of our clients. Our team is made up of a diverse pool of knowledge and research positions that allow us to pursue exciting, innovative research careers.ADDITIONAL INFORMATIONThe Data and Research Services (DRS) function is a dynamic and highly visible center of excellence focused on business research and process innovation. We collaborate with our consulting teams to bring advanced research capabilities to support projects and clients. DRS provides specialist research services to consulting teams and our Knowledge Team, taking deep pride in delivering rapid and precise results.

DRS works with both qualitative and quantitative data, conducting research and providing synthesized results from over 100 commercial sources, publicly available data, company and industry research, macro-economic, commodities and trade data.

You are a driven and motivated problem solver ready to pursue meaningful work. You strive to make an impact every day & not only at work, but in your personal life and community too. If that sounds like you, then you've landed in the right place.

Overview of Position: The Investment Advisory Group (IAG) is responsible for the day-to-day portfolio oversight, manager evaluation, selection, and ongoing due diligence in support of Hartford Funds, with approximately $130B in assets. IAG is seeking an Investment Research Analyst to assume direct ownership and responsibility for a group of funds within an asset class across Hartford Funds' mutual fund and ETF complex. This role will provide the opportunity for a highly motivated candidate to expand their knowledge base and learn new skills while partnering with and being mentored by more experienced members of the team. The incumbent will work with members of the investment research team to perform the day-to-day oversight process on our funds and provide investment support to a variety of internal clients.
Responsibilities of the role:
Act as a subject matter expert for a subset of mutual funds/ETFs, responsible for day-to-day oversight of investment strategies and providing investment support to Sales, Marketing, Product, and other internal clients Conduct due diligence and communicate findings with respect to investment performance and risk, outlook, and strategy to senior management and the Board of DirectorsUnderstand and analyze key trends within the asset class and positioning of competitors Conduct thorough portfolio analysis using Morningstar, Bloomberg, Factset and other tools Assist with enhancements of investment tools and processes to monitor markets, fund performance, investment risks, and competitors Collaborate with the broader organization on product positioning, product development, regulatory disclosures, marketing content, and investment insights

Qualifications:
BA/BS required; concentration in finance, economics or quantitative discipline very strongly preferred Strong interest in investing and an excellent grasp of financial markets along with desire to pursue continued education such as CFA, MBA, CIMA, preferred Knowledge of investment tools for performance analysis and portfolio analytics (i.e., FactSet, Bloomberg, Morningstar, Barra) a plus Strong data analytics, quantitative/technical skills - in particular with Excel and Factset preferred Prior experience involving financial analysis, accounting, security analysis, trading, product management, or fund evaluation/oversight viewed favorably Strong analytical, organizational, relationship building, writing and presentation skills Ability to take initiative, work independently, and in a team environment

Compensation
The listed annualized base pay range is primarily based on analysis of similar positions in the external market. Actual base pay could vary and may be above or below the listed range based on factors including but not limited to performance, proficiency and demonstration of competencies required for the role. The base pay is just one component of The Hartford's total compensation package for employees. Other rewards may include short-term or annual bonuses, long-term incentives, and on-the-spot recognition. The annualized base pay range for this role is:

$75,000 - $100,000

Equal Opportunity Employer/Females/Minorities/Veterans/Disability/Sexual Orientation/Gender Identity or Expression/Religion/Age

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Mgr Research Analyst - 87V26E
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