Senior Clinical Analyst
1st Solution USA - Boston, MA

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Our client is a leading software and solutions company that provides predictive modeling for the healthcare industry. They are seeking to hire a Senior Clinical Analyst . Joining a team that maintains a reputation as one of the top analytics groups in health care informatics, you will play an important role in supporting the development of the next generation of their products and services. In this role you will focus on logic building, informatics and problem solving and will be involved in developing a set of categories and service utilizations around claims data.

REQUIRED SKILLS & EXPERIENCE:
  • Must possess a Bachelor’s degree and ideally looking for someone with a Master’s degree in Information Science
  • A broad clinical background (ideally an RN or MD) such as a well-versed coder
  • 5-10+ years experience dealing with clinical analytics and capable of taking an entire project from conception to conclusion
  • Knowledge of medical coding and code sets (diagnosis, procedure, drug, administrative)
  • Knowledge of the processes (esp. periodic updates) related to medical code classification systems
  • Basic understanding of the ongoing transition to ICD-10 is essential
  • Knowledge of relational database theory (mainly related to using Access); Ability to use basic Access functions (import/export of data, creating/using tables and queries and macros)
  • Basic understanding of the distinctions between and features of the major U.S. health care coverage entities - Medicare, Medicaid, Commercial - and important sub-groups, such as Medicare Advantage, HMOs, PPOs
  • Basic understanding of risk adjustment methodology
  • Knowledge of new directions in U.S. healthcare - PPACA, insurance marketplaces, ACOs, "consumer driven" plans, PCMH, etc. is a plus
  • Knowledge of SNOMED, UMLS are pluses, but not essential
  • Ability to use SQL is a plus, but not essential.
We are ideally looking for local, Boston-area candidates.

1st Solution USA - 14 months ago - save job