Watson Health - Client Services Manager, Data Analytics

Job description

Candidate MUST be located in Des Moines, IA

The Data Analytics Manager is responsible for oversight of Watson Health's Iowa Medicaid Enterprise Program Integrity Data Analytics team. The Data Analytics Manager is responsible for designing and accurately completing a series of program integrity analytics used to identify and recover healthcare overpayments, identify managed care overpayment and underpayment issues, and benefit compliance issues. The Data Analytics Manager may also support the development of analytics focused on analyzing the quality of care received by Iowa Medicaid beneficiaries.

Essential Responsibilities
·  Work closely with the client and project team to develop and implement an annual analytic work plan.
·  Formally create, enhance and document policies and procedures as they relate to algorithm creation and completion.
·  Consistently examine progress against plan and prioritize schedules, ensuring analytic deliverables are completed timely and annual fiscal goals are met or exceeded.
·  Oversee the design, application, interpretation, documentation, and presentation of all comprehensive fraud, waste and abuse algorithms.
·  Design, execute and present complex analysis as a member of the analytic team.
·  Provide feedback and detailed review for all deliverables (algorithm programming, algorithm write-ups, letters, etc.) to guarantee deliverables are reliable and completed accurately.
·  Lead, supervise, train and coach internal analytic team with a customer-centered approach and attitude.
·  Facilitate effective weekly/bi-weekly analytic team meetings.
·  Address or delegate all ad-hoc data requests. Monitor progress and present details and recommendations to allow committee to decide on next steps.
·  Manage referrals to audit and investigation team and track provider case progress and needs.
·  Document the potential return on investment and/or recoveries for the client based on data analysis efforts.
·  Develop tools, reports and processes to effectively track cost avoidance.
·  Build and maintain data scripts and tools to further automate Fraud and Abuse Detection System (FADS) processes.
·  Participate in all relevant FADS meetings, such as audit committee meetings and management meetings.
·  Function as a consultant for upgrading and utilizing the case management system and its reports.
·  Serve as analytic resource and liaison between data management teams, project management, technical teams and analytic staff of proprietary systems.
·  Coordinate support for FADS client users of proprietary systems, including training and fielding ad-hoc questions.
·  Manage quarterly provider profile reports, identifying aberrant billers and peer group outliers.
·  Work with leadership and sales staff to support future contract/business proposals.
·  Assist in daily management tasks for entire FADS team, including personnel, staffing, technical, financial, goal-setting and other office-related issues.
·  Stay abreast with modifications made to claims processing systems or data warehouses by working with contractors to understand problems and propose solutions.
·  Work in partnership and support additional sub-contractors, ensuring they are performing consistently with contract expectations, and addressing any issues that may arise.
Auto req ID

239508BR
Required Education

Bachelor's Degree
Role ( Job Role )

Industry Consultant
State / Province

IOWA
Primary job category

Consultant
Company

(0147) International Business Machines Corporation
Contract type

Regular
Employment Type

Full-Time
ERBP

Yes
Is this role a commissionable/sales incentive based position?

No
Travel Required

No Travel
IBM Business Group

Watson Health
Preferred Education

Master's Degree
City / Township / Village

DES MOINES
Being You @ IBM

IBM is committed to creating a diverse environment and is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status. IBM is also committed to compliance with all fair employment practices regarding citizenship and immigration status.
Required Technical and Professional Expertise

·  Candidate MUST be located in Des Moines, IA
·  5+ years of experience applying healthcare analysis methods and measures utilizing basic statistical methods
·  3+ years managing/supervising staff
·  3+ Prior experience with health care claims, provider relations, program integrity, fraud and abuse
·  Experience in data evaluation and database development
·  Experience managing in a fast-paced, goal-oriented environment
·  Experience developing policies, procedures, processes and workflows
·  Excellent oral and written communication skills
·  Demonstrated ability to convey complex ideas in an easily understood manner to aid audience through written or verbal communications
·  Demonstrated ability to understand industry issues and problems, relate them to clients' needs, and propose appropriate solutions
Country/Region

United States
Preferred Technical and Professional Experience

·  MBA, JD OR MHA or Masters focused on healthcare or information technology (preferred).
·  Registered Health Information Administrator (RHIA certification), Certified Fraud Examiner (CFE) or Accredited Healthcare Fraud Investigator (AHFI) (preferred).
·  2-3 years State or Federal government experience either as employee or contractor.
·  2-3 years auditing experience.
·  Direct interaction with Medicaid or Medicare claims processing systems.
·  Demonstrated ability to work closely and collaboratively with a client.
·  Demonstrated project management, organization and prioritization skills.
·  Experience using DataProbe and J-SURS.
·  Experience using other analytic software such as SQL, Terradata, Cognos, Business Objects, Tableau, ArcGIS, SAS, SAS JMP, ACL, etc.
·  Knowledge of ICD, CPT, HCPCS, NDC & DRG code sets
Secondary Job Category

Other Consultant
Eligibility Requirements

None
Position Type

Professional
Early Professional Track

Not Applicable - Professional Hire
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About Business Unit

IBM Watson Health is pioneering a new partnership between humanity and technology with the goal of transforming global health and revolutionizing many aspects of the medical and pharmaceutical industries, as well as government sectors. We aspire to improve lives and give hope by delivering innovation to address the world's most pressing health challenges through data and artificial intelligence insights.
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