hello folks,
Please find the below requirement send only best consultants to *bal...@ntc-us.com <bal...@ntc-us.com>* *SQL DEVELOPER* *COLUMBUS, OH* *LONG TERM CONTRACT* *MOLINA HEALTHCARE CLIENT* *VISA COPY MUST* The most important software skills are: · SQL (querying, stored procedures, views, functions) · SSRS · Excel Other software skills that may be helpful are: · QNXT (our claims payment software) · SSIS (helpful but not a necessity ) This candidate will be working with our managed care plan’s financial data, claim data and provider data. More specifically, I am in need of an individual who is familiar with: · Working with Fee Schedules (these are long lists of approved payment amounts for various medical services provided by the State Government. We use these to reimburse our providers at a price aligned with the State’s billing expectations) o The candidate would compare the new rates against the previous, identify possible impact based on historical data, and manipulate the data to load into the QNXT claim processing system o We would like this candidate to be familiar with automation processes to help us automate the analysis and management of new fee schedules as we receive them using stored procedures and SSRS (possibly SSIS). · APR-DRG (grouper used for pricing hospital claims) o The candidate would manage our DRG pricing tool (built in SQL and Excel) which uses various fee schedules from the State to price claims correctly according to this methodology so we don’t overpay or underpay providers for DRG services. · EAPG (this is another grouper used for pricing outpatient claims) o This is very new, but if you have anyone with this experience it would be very helpful. A few other states are currently using this technology. It is similar to DRG pricing methodology. o This process is still being designed with the State Government but should go live in 2016. The candidate would assist in evaluating proposals and methodology from the State on how they plan to implement this tool. · Cost reporting o The candidate would be responsible for compiling quarterly cost reports with several other team members that detail our expenses in a categorical format defined by the State. Experience with formal financial reporting at a State or Federal level would be relevant. · Financial Comparisons / Strategic Analysis o The candidate would assist with identifying inefficiencies through our payment data to understand where we can create new programs / efficiencies to improve financial outcomes. An example would be identifying a subset of members that are using the ER more frequently than our other members on average and identifying causes of the issue that we need to address strategically. *Thanks & regards* *Balaji* *Marketing Analyst* *Neumeric Technologies Corp.|| Sudhi Infomatics Inc.* Office– 855-682-0050*102 || Direct – 216-930-4545 || Fax: 855.NTC.0049 Email - bal...@ntc-us.com, bal...@sudhi-infomatics.com <bal...@ntc-us.com,%20%20bal...@sudhi-infomatics.com> **www.ntc-us.com, www.sudhi-infomatics.com for further details Yahoo IM : balaji.utkar -- You received this message because you are subscribed to the Google Groups "OracleD2K" group. To unsubscribe from this group and stop receiving emails from it, send an email to oracled2k+unsubscr...@googlegroups.com. To post to this group, send email to oracled2k@googlegroups.com. Visit this group at http://groups.google.com/group/oracled2k. For more options, visit https://groups.google.com/d/optout.
