Qureos Mentor

Med-Metrix

Job Purpose
 The Senior Data Engineer designs, builds, and maintains scalable data pipelines and architectures to support the Denials AI workflow under the guidance of the Team Lead, Data Management. This role ensures data is reliable, compliant with HIPAA, and optimized.
 
Duties & Responsibilities
 
<ul>
<li>Collaborate with the Team Lead and cross functional teams to gather and refine data requirements for Denials AI solutions</li>
<li>Design, implement, and optimize ETL/ELT pipelines using Python, Dagster, DBT, and AWS data services (Athena, Glue, SQS)</li>
<li>Develop and maintain data models in PostgreSQL; write efficient SQL for querying and performance tuning</li>
<li>Monitor pipeline health and performance; troubleshoot data incidents and implement preventive measures</li>
<li>Enforce data quality and governance standards, including HIPAA compliance for PHI handling</li>
<li>Conduct code reviews, share best practices, and mentor junior data engineers</li>
<li>Automate deployment and monitoring tasks using infrastructure-as-code and AWS CloudWatch metrics and alarms</li>
<li>Document data workflows, schemas, and operational runbooks to support team knowledge transfer</li>
<li>Other duties as assigned</li>
<li>Use, protect and disclose patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards</li>
<li>Understand and comply with Information Security and HIPAA policies and procedures at all times</li>
<li>Limit viewing of PHI to the absolute minimum as necessary to perform assigned duties</li>
</ul>
Qualifications
 
<ul>
<li>Bachelor’s or master’s degree in Computer Science, Data Engineering, or related field</li>
<li>5+ years of hands on experience building and operating production grade data pipelines</li>
<li>Solid experience with workflow orchestration tools (Dagster) and transformation frameworks (DBT) or other similar tools such (Microsoft SSIS, AWS Glue, Air Flow)</li>
<li>Strong SQL skills on PostgreSQL for data modeling and query optimization or any other similar technologies (Microsoft SQL Server, Oracle, AWS RDS)</li>
<li>Working knowledge with AWS data services: Athena, Glue, SQS, SNS, IAM, and CloudWatch</li>
<li>Basic proficiency in Python and Python data frameworks (Pandas, PySpark)</li>
<li>Experience with version control (GitHub) and CI/CD for data projects</li>
<li>Familiarity with healthcare data standards and HIPAA compliance</li>
<li>Experience mentoring or leading small technical efforts</li>
<li>Proficiency in Microsoft Office Suite</li>
<li>Strong interpersonal skills, ability to communicate well at all levels of the organization</li>
<li>Strong problem solving and creative skills and the ability to exercise sound judgment and make decisions based on accurate and timely analyses</li>
<li>High level of integrity and dependability with a strong sense of urgency and results oriented</li>
<li>Excellent written and verbal communication skills required</li>
</ul>
Working Conditions
 <ul>
<li>Regular working hours; on-call for data pipeline incident response.</li>
<li>Physical Demands: While performing the duties of this job, the employee is occasionally required to move around the work area; Sit; perform manual tasks; operate tools and other office equipment such as computer, computer peripherals and telephones; extend arms; kneel; talk and hear.</li>
<li>Mental Demands: The employee must be able to follow directions, collaborate with others, and handle stress.</li>
<li>Work Environment: The noise level in the work environment is usually minimal.</li>
</ul>
Med-Metrix will not discriminate against any employee or applicant for employment because of race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), parental status, national origin, age, disability, genetic information (including family medical history), political affiliation, military service, veteran status, other non-merit based factors, or any other characteristic protected by federal, state or local law.

Senior Data Engineer

Job Purpose
 The Medical Claims Analyst is responsible for collections, account follow up, billing and allowance posting for the accounts assigned to them.
 
Duties and Responsibilities
 <ul>
<li>Follow-up with payers to ensure timely resolution of all outstanding claims, via phone, emails, fax or websites</li>
<li>Meets and maintains daily productivity/quality standards established in departmental policies</li>
<li>Uses the workflow system, client host system and other tools available to them to collect payments and resolve accounts</li>
<li>Adheres to the policies and procedures established for the client/team</li>
<li>Knowledge of timely filing deadlines for each designated payer</li>
<li>Performs research regarding payer specific billing guidelines as needed</li>
<li>Ability to analyze, identify and resolve issues causing payer payment delays</li>
<li>Ability to analyze, identify and trend claims issues to proactively reduce denials</li>
<li>Communicates to management any issues and/or trends identified</li>
<li>Initiate appeals when necessary</li>
<li>Ability to identify and correct medical billing errors</li>
<li>Send appropriate appeals, accurate requesting information, supporting documentation, and effective communication to complete recovery process</li>
<li>Understanding of under or over payments and credit balance processes</li>
<li>Assist with special A/R projects as needed. Analytical skills and the ability to communicate results are required</li>
<li>Act cooperatively and courteously with patients, visitors, co-workers, management and clients</li>
<li>Work independently from assigned work queues</li>
<li>Maintain confidentiality at all times</li>
<li>Maintain a professional attitude</li>
<li>Other duties as assigned by the management team</li>
<li>Use, protect and disclose patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards</li>
<li>Understand and comply with Information Security and HIPAA policies and procedures at all times</li>
<li>Limit viewing of PHI to the absolute minimum as necessary to perform assigned duties</li>
</ul>
Qualifications
 <ul>
<li>Completed at least High School education</li>
<li>Minimum 1 year of Healthcare Account Receivable/Collections in a BPO setting or environment (claims payments processing, claims status and tracking, Medical Billing, AR Follow ups, Denials and Appeals-outbound healthcare providers)</li>
<li>Experienced on medical billing/ AR Collections</li>
<li>Background in calling insurance (Payer) to verify claim status and payment dispute</li>
<li>Strong interpersonal skills, ability to communicate well at all levels of the organization</li>
<li>Strong problem solving and creative skills and the ability to exercise sound judgment and make decisions based on accurate and timely analyses</li>
<li>High level of integrity and dependability with a strong sense of urgency and results oriented</li>
<li>Excellent written and verbal communication skills required</li>
<li>Gracious and welcoming personality for customer service interaction</li>
</ul>
Working Conditions
 <ul>
<li>Must be amenable to work night shifts</li>
<li>Physical Demands: While performing the duties of this job, the employee is occasionally required to move around the work area; Sit; perform manual tasks; operate tools and other office equipment such as computer, computer peripherals and telephones; extend arms; kneel; talk and hear.</li>
<li>Mental Demands: The employee must be able to follow directions, collaborate with others, and handle stress.</li>
<li>Work Environment: The noise level in the work environment is usually minimal.</li>
</ul>
Med-Metrix will not discriminate against any employee or applicant for employment because of race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), parental status, national origin, age, disability, genetic information (including family medical history), political affiliation, military service, veteran status, other non-merit based factors, or any other characteristic protected by federal, state or local law.

Medical Claims Analyst

Job Purpose
 
The Senior Database Developer will be responsible for analyzing, developing SSIS projects, custom reports and work closely with the team on any SQL issues.
 
Duties & Responsibilities
 
<ul>
<li>Develop SSIS projects to handle ETL, transmission, encryption, and archiving of files received and generated SQL Database Tuning and Performance</li>
<li>Design, develop, and maintain database tables, stored procedures, and supporting objects</li>
<li>Build and support operational reports for company and clients</li>
<li>Work with data team to provide operational support, resolve recurring problems</li>
<li>Document database topology, architecture, processes and procedures</li>
<li>Develop SQL queries and support ad hoc requests for data</li>
<li>Assist with capacity planning and resource expansion through data aggregation and analysis</li>
<li>Work with project managers to ensure that reports and metrics identify business needs and opportunities for process improvement</li>
<li>Identify inefficiencies in the database platform and provide solutions to the management</li>
<li>Use problem-solving skills to assist in resolution of business problems</li>
<li>Develop analytical skills to resolve technical problems</li>
<li>Identify root causes for problems and propose solutions to prevent recurring.</li>
<li>Use, protect and disclose patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards</li>
<li>Understand and comply with Information Security and HIPAA policies and procedures at all times</li>
<li>Limit viewing of PHI to the absolute minimum as necessary to perform assigned duties</li>
</ul>
Qualifications
 
<ul>
<li>Four-year degree in Computer Science/Information Technology required</li>
<li>Minimum five years working as a Database engineer or a related role</li>
<li>Minimum of three years SSIS experience</li>
<li>Minimum of two years’ experience with C# and\or VB.NET</li>
<li>Thorough understanding of database structures, theories, principles, & practices</li>
<li>Ability to write & troubleshoot SQL code & design stored procedures, functions, tables, views, triggers, indexes, & constraints</li>
<li>Extensive knowledge of MS SQL Server 2012 or later</li>
<li>Extensive knowledge with SSRS\SSIS\T-SQL</li>
<li>Experience with C# and\or VB.NET.</li>
<li>Technical knowledge of MS SQL Server internals with emphasis on query performance</li>
<li>Knowledge and know-how to troubleshoot potential issues; experience with best practices around database operations</li>
<li>Require ability to work independently with minimal supervision</li>
<li>Ability to multi-task with several complex and demanding projects</li>
<li>Strong interpersonal skills, ability to communicate well at all levels of the organization</li>
<li>Strong problem solving and creative skills and the ability to exercise sound judgment and make decisions based on accurate and timely analyses</li>
<li>High level of integrity and dependability with a strong sense of urgency and results oriented</li>
<li>Excellent written and verbal communication skills required</li>
</ul>
Working Conditions
 <ul>
<li>Physical Demands: While performing the duties of this job, the employee is occasionally required to move around the work area; Sit; perform manual tasks; operate tools and other office equipment such as computer, computer peripherals and telephones; extend arms; kneel; talk and hear.</li>
<li>Mental Demands: The employee must be able to follow directions, collaborate with others, and handle stress.</li>
<li>Work Environment: The noise level in the work environment is usually minimal.</li>
</ul>
Med-Metrix will not discriminate against any employee or applicant for employment because of race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), parental status, national origin, age, disability, genetic information (including family medical history), political affiliation, military service, veteran status, other non-merit based factors, or any other characteristic protected by federal, state or local law.

Senior Database Developer

Job Purpose
 The Physician Advisor performs case reviews of all case types in a knowledgeable and conscientious manner to achieve the highest degree of compliance. The Physician Advisor works closely with the Client’s medical staff leadership, the entire medical staff, including resident physician house staff, all areas of resource management, case management, social services, discharge planning, and utilization management to recommend methods to optimize use of hospital services for all patients. This includes identifying opportunities to optimize length of hospital stay and efficient management of resources, ensuring patients are in the appropriate level of care, supporting documentation, coding improvements and compliance, and monitoring the appropriate use of diagnostic and therapeutic modalities.
 
Duties and Responsibilities
 <ul>
<li>Responds to requests for assistance on clinical reviews for medical necessity or any other reason, by any member of the Case Management department in a timely fashion</li>
<li>Provides consultation to attendings, nurses, and case management staff regarding complex clinical issues and advises on justification required for continued stay, medical necessity and utilization management</li>
<li>Obtains familiarity and working knowledge of standard published criteria such as MCG/InterQual and applies professional judgment and patient specific variables as may be necessary or justifiable</li>
<li>Maintains accountability for achieving case management outcomes and fulfills the obligations and responsibilities of the role to support the medical staff in the clinical progression of patient care</li>
<li>Describes ways to provide improved health record documentation that specifically affect ICD code assignment capture of severity, acuity, risk of mortality, and DRG assignment</li>
<li>Participates in ongoing training and education related to the Physician Advisor role and responsibilities including topics related to Utilization Management, Care Management and other related areas as requested</li>
<li>Meets productivity and quality standards within established time requirements. Work product and performance meets or exceeds quality standards.</li>
<li>Achieve performance goals as outlined in employment agreement</li>
<li>Maintains confidentiality of patient care and business matters</li>
<li>Demonstrates behavior that supports the organization’s mission. Participates in required orientation and training related to the Physician Advisor role</li>
<li>Demonstrates commitment to meeting/exceeding strategic initiatives of organization</li>
<li>Upholds the organization’s values of teamwork and professionalism and applies Code of Conduct standards to all members of the healthcare team</li>
<li>Facilitate, mentor, and educate other physicians regarding payer requirements</li>
<li>Attends all meetings as requested by PAOC leadership</li>
<li>Participate in the peer review process as may be necessary or requested</li>
<li>Maintain medical licensure and board certification in good standing</li>
<li>During scheduled work hours, commits full attention to Physician Advisory and execution of outlined tasks</li>
<li>Use, protect and disclose patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards</li>
</ul>
Qualifications
 <ul>
<li>Board Certified and licensed to practice medicine in the US or 3+ years active clinical experience in the US</li>
<li>3+ years working as a Physician Advisor performing Level of care reviews as well as Peer to Peer Reviews</li>
<li>Basic technical skills with Hospital EMRs, Microsoft Office and Teams a must</li>
<li>Hold and maintain an unrestricted medical license and Board Certification</li>
<li>Possess or acquires a solid foundation, knowledge, and/or experience in the areas of utilization management, quality improvement, and patient safety</li>
<li>Possess a working knowledge of (Hospital) organization & case management operations and administrative standards and policies</li>
<li>Familiarity with MCG/InterQual placement status criteria is preferred</li>
<li>Member of the American College of Physician Advisors (ACPA) preferred</li>
<li>Board Certification by the American Board of Quality Assurance and Utilization Review Physicians, Inc. (ABQAURP) preferred</li>
<li>Physician Advisor Sub-Specialty Certification by the American Board of Quality Assurance and Utilization Review Physicians, Inc. (ABQAURP) preferred</li>
<li>Excellent customer service and interpersonal skills and the utmost professionalism is required</li>
<li>Able to effectively present information, both formal and informal</li>
<li>Strong analytical skills</li>
<li>Strong written and verbal communications skills with all levels of internal and external customers</li>
<li>Strong organizational skills and ability to set priorities and multi-task, demonstrates flexibility, teamwork, and is accustomed to change in the healthcare environment</li>
<li>Demonstrates ability to drive results and produce outcomes</li>
<li>Demonstrates initiative as well as basic independent trouble-shooting skills</li>
</ul>
Working Conditions
 <ul>
<li>This role requires availability to provide a minimum of 16 shifts per month. Each shift is 6-8 hours in duration and includes 4 weekend shifts per month.</li>
<li>Physical Demands: While performing the duties of this job, the employee is occasionally required to move around the work area; Sit; perform manual tasks; operate tools and other office equipment such as computer, computer peripherals and telephones; extend arms; kneel; talk and hear.</li>
<li>Mental Demands: The employee must be able to follow directions, collaborate with others, and handle stress.</li>
<li>Work Environment: The noise level in the work environment is usually minimal.</li>
</ul>
Med-Metrix will not discriminate against any employee or applicant for employment because of race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), parental status, national origin, age, disability, genetic information (including family medical history), political affiliation, military service, veteran status, other non-merit based factors, or any other characteristic protected by federal, state or local law.
 
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Physician Advisor - Fully Remote

Medical Claim Analyst

Join Med-Metrix and explore 5   exciting career opportunities. They're hiring for various roles with options for remote or on-site work. Apply today and become part of their innovative team.

Med-Metrix

ABOUT_COMPANY

Senior Data Engineer

Medical Claims Analyst

Senior Database Developer

Physician Advisor - Fully Remote

Medical Claim Analyst