Aridell Associates, LLC

​Serving tHE Healthcare,

Financial, Insurance, and Public SectorS

Current Job Opportunities

Job Title: Part C Subject Matter Expert (Part-Time/Full-Time)
Post Date: 12/14/2023 – 12/31/2023

Position Summary
Aridell Associates, LLC, a professional consulting firm, advises clients on healthcare program operations and helps clients develop solutions to maximize meaningful outcomes, improve their operations, and protect their valuable assets, as well as bestow customer confidence in their operations.  Our mission is to advance clients’ operational performance and provide sustainable long-term, successful business strategies.

If you are interested in providing consulting and advisory services or supporting contracts, then this operational support position is for you.  The Part C Subject Matter Expert serves as an integral member of a multi-disciplinary team in supporting audits, data analysis projects, and program vulnerability studies focused on health plans for a contract. In this position, you will conduct research; collaborate on developing audit and analytical approaches, methodologies, and strategies; perform fieldwork, and report results. The Part C Subject Matter Expert will receive all direction and instructions from a program manager or their designee for the work activities under a contract.  


Responsibilities

  • Develop solutions, alternative practices, or strategies to detect and prevent FWA.
  • Gather and organize information about a problem to be solved or the procedure or process to be improved.
  • Analyze financial, operational, and performance data, information, and other forms of evidence.
  • Participate in on-site and off-site audit activities.
  • Interact and confer with team members on a variety of topics, such as ideas, projects, approaches, methodologies, and strategies, using all forms of available communications.
  • Identify and aid in the development of best practices for conducting audits, analytics, and program vulnerability studies.
  • Review and analyze encounter data, fee-for-service claims, enrollment data, prescription drug event records, and other data sources in providing advice, input, and recommendations.
  • Interpret Medicare and Medicaid policies, laws, rules, regulations, manuals, and healthcare industry guidelines in conducting audit, analytical, and program vulnerability study activities.
  • ​Educate and explain healthcare payment models (e.g., capitation and risk adjustment payment models), coding practices, and the coding process to clients and team members as needed.
  • Serve as a technical resource in health plan operations and data.Mentor, educate, and train other audit and analytical personnel, as well as partners and stakeholders. 


Qualifications

  • The position requires a bachelor’s degree in business administration or related field. The nature of the work requires a minimum of 20 years of experience supporting government and private program integrity operations. Experience working for a health plan, regulatory government agency, special investigation unit, and program integrity contractor is preferred.
  • Must possess substantial familiarity with federal healthcare programs, such as Medicare and Medicaid, and the governing laws, rules, regulations, and policies. Preference is given to candidates with outstanding organizational, time management, and interpersonal skills; superior technical writing and research ability; and a demonstrated commitment to professionalism and ethics.
  • The role requires one with a familiarity of audit, data analysis, and program vulnerability operations and CMS program integrity contracts.

 
Skills

  • Requires professional presentation skills.
  • Strong organizational planning and prioritization skills with the ability to collaborate with others and multi-task.
  • Excellent written and verbal communication skills.
  • Ability to present to large or small groups when required.
  • Proficient in using the Microsoft Office Professional Suite, including Word, Excel, PowerPoint, and Outlook.


Travel Requirements
No travel is required.


Job Location
This is a work-from-home/remote position.

Apply Now
Email a cover letter and resume To: jarias@aridell.com​​​