Clinical Content Specialist (698-866)

Hayes Management Consulting Inc Newton Center , MA 02459

Posted 3 weeks ago

Join Hayes as we optimize the business of healthcare for the nation's premier healthcare organizations.

From day one, you will have the opportunity to make a difference for our clients, who represent the nation's premier healthcare systems within academic and for-profit institutions. We are seeking the best of the best in clinical content, and we want you to challenge us to deliver unparalleled content to our SaaS-based software clients. If you are looking for a "behind the scenes" role, this isn't the job for you. We celebrate driven professionals who thrive in a collaborative environment.

This position will be responsible for review and analysis of current Medicare medical policies and assisting in the research necessary to define additional logic and algorithms to expand the MDaudit Risk Adjustment library.

This role is based in our headquarters office in Wellesley, MA.

Required Skills

  • Experience in Medicare/Caid with focus on reimbursement and/or claims processing or equivalent experience through a payer services organization working with Medicare/ State Medicaid plans

  • Understanding of clinical/medical terminology and coding systems (i.e. ICD10, HCPCS/CPT, DRG, LCD/NCDs, RVUs, APGs)

  • Experience developing medical payment policy edits or algorithms is preferred

  • Must have a clinical background, preferably in nursing or other licensed healthcare profession (i.e. RN, NP, PA, PT, OT)

  • Experience working with healthcare software (preferably in a SaaS environment) is preferred

  • Must be MS Office proficient

  • Knowledge and familiarity of OIG and CMS regulations is highly desirable

  • M*

Position Type Full-Time/Regular


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Clinical Content Specialist (698-866)

Hayes Management Consulting Inc