Gx Gov - Lead Optimization Audit Specialist

Remote Jobs; United States; Remote; USD 100,000 - 123,000; Full time

Job summary

A leading company in healthcare services is seeking an experienced professional to design and maintain audit processes. This role offers competitive compensation up to $122,100, potential bonuses, and opportunities for career growth. Join a collaborative team dedicated to improving patient outcomes in a supportive environment.

Qualifications

• Minimum 2 years relevant experience in a similar role.
• 4+ years relevant work experience, including case management.
• Strong communication skills to work collaboratively.

Responsibilities

• Design and maintain Lead Optimization and Governance Audits.
• Conduct regular audit activities for DMEMs and Rules.
• Communicate audit findings and support management of CPT activities.

Skills

Problem-solving

Attention to detail

Communication

Interpersonal skills

Education

Degree or equivalent

Tools

SAP

PowerBi

Salesforce.com

Job description

Employer Industry: Healthcare Services

Why consider this job opportunity:
- Salary up to $122,100
- Potential for annual bonuses and long-term incentive opportunities
- Opportunity for career advancement and growth within the organization
- Supportive and collaborative work environment
- Chance to make a positive impact on healthcare practices and patient outcomes
- Emphasis on a culture of empowerment and innovation

What to Expect (Job Responsibilities):
- Design and maintain Lead Optimization and Governance Audits, ensuring accuracy and integrity
- Conduct regular audit activities for DMEMs and Rules to ensure compliance and identify discrepancies
- Communicate audit findings and exceptions to relevant stakeholders for resolution
- Support the management of CPT substitution activities and monitor automated workflows
- Provide clearly defined use cases and value propositions for new tools and processes

What is Required (Qualifications):
- Minimum educational requirement: Degree or equivalent
- Typically requires 2+ years of relevant experience in a similar role
- 4+ years of relevant work experience, including case management
- Strong problem-solving skills and attention to detail
- Excellent communication and interpersonal skills, with the ability to work collaboratively with cross-functional teams

How to Stand Out (Preferred Qualifications):
- Experience with SAP and PowerBi
- Familiarity with automated workflow systems like Salesforce.com
- Knowledge of pricing mechanisms and their impact on downstream processes
- Familiarity with Pharma pricing vehicles (leads) and substitution concepts

#HealthcareServices #DataAudits #CareerOpportunity #CompetitivePay #ContinuousImprovement

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