Qureos Mentor

North East Medical Services

<div><div><div>The Clinical Data Scientist serves as a strategic bridge between clinical operations, Epic analytics and research initiatives at NEMS. This role will design, build, and validate reproducible analytical workflows and machine learning models using clinical and real‑world data (EHR, claims, registries) to answer clinical and operational questions, support research and product development, and enable data‑driven decision making across the organization.</div></div><p>
</p><div><div><b>ESSENTIAL JOB FUNCTIONS:</b></div></div><p>
</p><ul><li><div>Acts as liaison between IT, clinical informatics, operations and research teams to ensure alignment on clinical data strategy</div></li><li><div>
Designs and executes study and analysis plans for clinical research, outcome measurement, and predictive modeling.</div></li><li><div>
Analyzes patient populations to identify care gaps, utilization patterns, and opportunities for preventive interventions</div></li><li><div>
Supports value-based care initiatives by calculating and monitoring quality measures that impact reimbursement and funding</div></li><li><div>
Collaborates with care management, population health and other operational teams where needed to optimize provider engagement, patient engagement and outreach campaigns</div></li><li><div>
Partners with interdepartmental leaders, clinical directors and quality teams to gather requirements and prioritize analytics projects</div></li><li><div>
Serves as SME for analytics team; validates clinical workflows and data definitions</div></li><li><div>
Extracts, cleans, harmonizes, and curates clinical and real‑world datasets (EHR, claims, labs, device data), ensuring provenance and reproducibility.</div></li><li><div>
Develops feature engineering pipelines and statistical or machine‑learning models (risk scores, phenotyping algorithms, prognostic/predictive models)</div></li><li><div>
Validates models using appropriate methods (cross‑validation, temporal validation, external cohorts) and assesses fairness, calibration, and clinical utility</div></li><li><div>
Collaborates closely with clinicians, biostatisticians, product managers, and engineers to translate clinical questions into analytic specifications and actionable outputs</div></li><li><div>
Implements production‑ready pipelines and supports model deployment, monitoring, and lifecycle management (versioning, performance tracking, drift detection)</div></li><li><div>
Ensures compliance with data governance, privacy, and security requirements (HIPAA best practices); participates in data access and IRB processes as needed</div></li><li><div>
Produces clear, reproducible documentation, analysis code, technical reports, and visualizations for both technical and non‑technical stakeholders</div></li><li><div>
Contributes to team best practices: code review, unit/integration testing for analytics code, and reproducible research practices (notebooks, containers, CI/CD)</div></li><li><div>
Tracks project timelines, deliverables and stakeholder satisfaction metrics using project management tools &ndash; Jira or similar</div></li><li><div>
Performs other job duties as required by manager/supervisor</div></li></ul><ul><li><div>
Clinical Degree: MD, DO, NP, PA, PharmD, or equivalent clinical training with active understanding of clinical workflows, diagnoses, and treatment protocols preferred</div></li><li><div>
MS in Data Science, Biostatistics, Epidemiology, Computer Science, Biomedical Informatics, or related quantitative discipline (or equivalent experience or related field).</div></li><li><div>
5+ years&rsquo; experience working with clinical or real‑world healthcare data (EHR, claims, registries) in applied analytics or research settings</div></li><li><div>
Experience working with underserved or immigrant populations; cultural competency and multilingual skills highly valued</div></li><li><div>
Epic Certification required or must obtain within 6 months of hire</div></li></ul><p>
</p><div><div><b>Technical Skills and Competencies</b>:</div></div><ul><li><div>
Data Visualization tools (Power BI, Tableau or similar)</div></li><li><div>
Strong programming skills in Python and/or R; proficiency with SQL for large‑scale data extraction and manipulation</div></li><li><div>
Deep understanding of quality measures (HEDIS, eCQM), value-based care models and population health principles</div></li><li><div>
Experience with healthcare data standards and APIs (FHIR, HL7) and common EHR systems (Epic, Cerner) preferred</div></li><li><div>
Strong analytical rigor and attention to detail</div></li><li><div>
Excellent written and verbal communication skills with experience presenting technical results to clinicians and stakeholders</div></li><li><div>
Proactive problem solver with a bias for reproducible, production‑quality work</div></li><li><div>
Comfortable with ambiguity and rapidly evolving requirements in healthcare settings</div></li></ul><p>
</p><div><div><b>LANGUAGE:</b></div></div><p>
</p><ul><li><div>Must be able to fluently speak, read and write English</div></li><li><div>
Fluent in Chinese (Cantonese and/or Mandarin), Vietnamese, Spanish and other languages preferred</div></li><li><div>
Fluency in other languages are an asset</div></li></ul><p>
</p><div><div><b>STATUS:</b></div></div><p>
</p><ul><li><div>This is an FLSA Exempt position.</div></li><li><div>
This is not an OSHA low-risk position.</div></li><li><div>
This is a Full Time position.</div></li></ul><p>
NEMS is proud to be an Equal Opportunity Employer welcoming diversity in our workforce. Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.</p><p>
NEMS BENEFITS: Competitive benefits, including free medical, dental and vision insurance for employee, spouse and/or children; and company contribution to 401(k).<br>
</p><p>#LI-DNI</p></div>

CLINICAL DATA SCIENTIST

<div><p><b>SUMMARY OF POSITION:</b><br>
</p><p>The Patient Account Specialist I interprets EOBs for correct payment verification, adjustments, and denials. The Patient Account Specialist I is also responsible for handling outstanding claims on aging reports and resolving patient inquiries regarding billing statements and insurance overage-related matters. The Patient Account Specialist I has to maintain up-to-date knowledge about CPT, ICD-10 CM, billing regulations, and payers' requirements. The Patient Account Specialist I has to comply with HIPAA guidelines and maintain confidentiality regarding patient account status and the organization's financial affairs.</p><p>
</p><h1 class="jobSectionHeader"><b>ESSENTIAL JOB FUNCTIONS:</b></h1><ul><li>
Reviews, edits, processes, and submits <b>electronic and hardcopy claims</b> to various payers (Medicare, Medicaid, Managed Care, and Private Insurance) for <b>FQHC (Federally Qualified Health Centers)</b> and <b>FFS (Fee-For-Service)</b> reimbursement, ensuring accuracy of payment entries and completeness of charge capture information.</li><li>
Maintains up-to-date knowledge of <b>medical billing requirements</b> for FQHC Medi-Cal, Medicare, state, local programs, and private insurance payers.</li><li>
Reports issues or payment trends (e.g., charges applied to the wrong visit, incorrect billing codes) to the supervisor for resolution.</li><li>
Edits charge/claim details and corrects submission errors to ensure accuracy.</li><li>
Researches and resolves outstanding claims on <b>aging reports</b> to minimize delays in reimbursement.</li><li>
Responds to <b>payer requests and remittance advices</b> promptly and professionally, including phone calls, letter responses, appeals, and submission of medical records or additional information as required.</li><li>
Under the guidance of the <b>Patient Account Specialist II</b>, addresses patient inquiries and billing complaints by making necessary adjustments, exploring all options to secure claim payments, referring complex issues to appropriate staff, and ensuring proper follow-up.</li><li>
Posts charges and submits claims for <b>NEMS physicians&rsquo; hospital visits</b>.</li><li>
Provides <b>training and support</b> to the Billing Department and front desk staff in Member Services, Medical, Dental, Optometry, Laboratory, and Radiology Departments.</li><li>
Adheres to policies and procedures for <b>billing records retention</b>.</li><li>
Acts as a <b>liaison</b> between physicians, insurance companies, and third-party organizations by processing and verifying invoices, ensuring claim reimbursements, and auditing patient accounts.</li><li>
Performs additional duties as assigned by management.</li></ul><h1 class="jobSectionHeader"><b>
</b></h1><p></p><ul><li>Completion of an AA/AS degree is required, and a 4-year university diploma is preferred or maybe substituted with a minimum of 3 years of work experience in healthcare.
</li><li>Working experience in a healthcare or FQHC setting is preferred</li><li>
Working experience with Epic PB Resolute is preferred</li><li>
Familiar with Medicare, Medicaid, Private insurances, Managed Care (HMO &amp; PPO), CPT, and ICD-10 CM</li><li>
Must have excellent analytical and communication skills</li><li>
Must be proficient in computer skills</li><li>
Ability to write business correspondence</li><li>
Strong organizational skills to coordinate multiple, varied billing processes simultaneously</li><li>
Upholds high customer service standards in a demanding and complex health care organization</li><li>
Demonstrates initiative, resourcefulness, integrity and dedication to timeliness to achieve high customer satisfaction levels</li>
Self-motivated, diligent, organized, resourceful, responsible, and enthusiastic<br>
<li>
</li></ul><p><b>LANGUAGE:</b></p><ul><li>
Proficient in written and spoken English and Chinese (Cantonese and/or Mandarin)</li>
Fluent in other languages is an asset<br>
<li>
</li></ul><p><b>STATUS:</b></p><ul><li>
This is an FLSA Non-exempt position.
</li><li>This is not an OSHA high-risk position.</li>
This is a Full Time position.<br>
<li>
</li></ul><p>NEMS is proud to be an Equal Opportunity Employer welcoming diversity in our workforce. Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.</p><p>
NEMS BENEFITS: Competitive benefits, including free medical, dental and vision insurance for employee, spouse and/or children; and company contribution to 401(k).</p></div>

PATIENT ACCOUNT SPECIALIST I

Join North East Medical Services and explore 2   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.

North East Medical Services

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CLINICAL DATA SCIENTIST

PATIENT ACCOUNT SPECIALIST I