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- Assist statistical colleagues and study personnel to provide input to statistical analysis plans
- Program tables and maps using publicly available datasets
- Collaborate in the planning and implementation of data quality assurance plans including questionnaire development, data collection, and data management
- Maintain proficiency with respect to applicable SAS programming and statistical methodology and in applying new and varied methods
- Assist in statistical analyses with other staff
- Effectively justify methods selected and implement previously outlined analysis plans
- Conduct peer-review of work products from statistical colleagues
- Assist in writing reports and communicating results
- Conducts medical utilization audits to ensure quality control.
- Provides recommendations to the client on health care policy and procedure development.
- Provides expertise on pricing methodologies, including the Federal Employees’ Compensation Act (FECA), Diagnosis Related Groups (DRGs), Cost to Charge Ratio (CCR), the Outpatient Prospective Payment System (OPPS), Centers for Medicare and Medicaid Services (CMS) PPS Exempt Cancer Hospitals, and other PPS methodologies.
- Develops pricing recommendations for unlisted, miscellaneous, and unpriced codes using FECA, CMS, and other fee schedules.
- Provides training to the client and other stakeholders on proper medical claims billing, pricing methodologies and Program policies and procedures.
- Creates a quarterly FECA fee schedule and recommends annual rates for roll-up codes for Monitoring and Survivor Screening visits.
- Updates and maintains a pricing calculator for FECA rates by zip code.
- Conducts policy and pricing research on other Federal payors, including CMS, Tricare, Veterans Affairs (VA), and the Office of Workers’ Compensation Programs (OWCP).
- Works with the Provider Relations Team to answer provider questions on policy and pricing issues.
- Responds to medical claims appeals.
- Conducts ad hoc research for the internal team and the client.