Lead Clinical Content Strategist

1 week ago

Tampa, Florida, United States Apixio Full time
Job Overview

Company Overview:

Apixio is at the forefront of transforming healthcare by integrating health plans and providers through a pioneering Connected Care platform. Our mission is to reduce inaccuracies in reimbursement and enhance patient care quality as the industry transitions to value-based reimbursement models.

By combining healthcare expertise with advanced AI/machine learning technologies and data analytics, we deliver innovative solutions that create value for our clients and the broader healthcare ecosystem. Our goal is to facilitate the shift towards alternative payment models while improving efficiency and supporting superior patient outcomes.

Position Summary:

The Clinical Solutions Development Manager plays a critical role in the creation and oversight of our clinical offerings, which include Readmissions, Place of Service, Level of Care, and APR-DRG validation concepts. This position demands a deep understanding of healthcare payment systems and auditing criteria to effectively target significant claims for review and recovery. Proven expertise in content creation, claims recovery, and APR-DRG methodologies is vital.

Key Responsibilities:

  • Content Strategy: Formulate innovative approaches to enhance claim selection processes, significantly bolstering payment integrity for our clients.
  • Data Management: Utilize data analysis skills and strong organizational capabilities to refine proprietary tools, ensuring the highest standards of payment accuracy.
  • Claim Methodology: Apply a thorough understanding of claim selection techniques to improve methodologies that enhance claim selection strategies, particularly for inpatient claims.
  • Clinical Solutions Enhancement: Leverage expertise to assist in the improvement and evaluation of readmissions, place of service, and other clinical solutions.
  • Collaborative Development: Partner with a diverse team of programmers, operations personnel, product leaders, and auditors to translate DRG process concepts into actionable implementations.
  • Regulatory Compliance: Review and modify written guidelines by assessing their effectiveness, staying updated with regulatory changes, and making necessary adjustments.
  • Performance Evaluation: Monitor the effectiveness of existing and new concepts, continually adjusting strategies to optimize performance and outcomes.
  • Analytical Problem-Solving: Exhibit analytical skills to identify issues and trends, devise solutions, and implement actionable plans.
  • Policy Development: Create departmental policies, processes, and training standards.
  • Support and Evidence Provision: Supply internal and external stakeholders with evidence and references that align with industry standards, auditing protocols, and review methodologies.
  • Solution Collaboration: Work with a multi-disciplinary team to propose solutions that encompass operations, product development, data analytics, and technology.
  • Project Management: Establish timelines and ensure effective communication regarding progress, tracking deliverables, and addressing any roadblocks.
  • Program Implementation: Design and execute effective programs to identify and rectify claims with irregular results, providing feedback to address root causes.
  • Research and Special Initiatives: Assist with research, special projects, and ad hoc claim evaluations as required.
  • Proof of Concept Support: Provide review assistance for proof of concepts or sales initiatives when necessary.

Qualifications:

  • Bachelor's degree in health administration, business, or nursing.
  • Minimum of 5 years of experience in healthcare billing and coding.
  • At least 3 years of experience in claims auditing and recovery auditing.

Experience Requirements:

  • Extensive background in APR-DRG methodology for clinical content development.
  • Demonstrated ability to collaborate within a team, sharing DRG audit process insights with sales, marketing, and development teams.
  • In-depth knowledge of classification systems, including MSDRG, APR DRG, AP DRG, and outpatient payment systems such as APCs and EAPGs.
  • Strong analytical skills with a focus on understanding root causes of events and behaviors.
  • Proficient in data utilization and insights generation.
  • Experience in structuring and executing complex analyses independently.
  • Familiarity with Milliman and InterQual guidelines.
  • Expertise in DRG validation processes.
  • Experience in team management and production oversight.
  • Knowledge of Readmission review processes.
  • Ability to work efficiently with minimal supervision.
  • High standards of quality and meticulous attention to detail.
  • Comprehensive understanding of Medicare and Commercial coding regulations and prospective payment systems.
  • Expert knowledge of healthcare coding, billing, reimbursement, and claims adjudication standards.
  • Subject matter expertise in APR-DRG validation, Readmissions, and Place of Service.

Technical Skills:

  • Experience with multiple monitor setups.
  • Proven success in remote work environments.
  • Proficient in Microsoft Office Suite, including Excel, PowerPoint, and Word.
  • Experience with various software applications and collaboration with development teams.
  • Familiarity with multiple encoder/grouper applications.

Physical Requirements:

  • Ability to sit or stand for extended periods, with occasional bending and reaching.
  • May require lifting up to 25 pounds.
  • Normal range of vision and hearing, with or without accommodations.
  • Position is not significantly exposed to adverse environmental conditions.

Compensation:

The salary range for this position is $70,000—$115,000 USD, with total compensation including benefits and variable compensation determined by factors such as skill set, experience, and geographic location.

What We Offer:

  • Meaningful work that advances healthcare.
  • Competitive salary and exceptional benefits, including medical, dental, and vision coverage.
  • 401k plan with company matching.
  • Generous vacation policy.
  • Remote-first and hybrid work options.
  • Subsidized gym memberships and catered lunches.
  • Engaging company culture with events and activities.

Equal Opportunity Statement:

We are committed to equal employment opportunities for all individuals, regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender identity or expression, or veteran status.

  • Technical Content Strategist

    1 week ago

    Tampa, Florida, United States DigitalCM LLC Full time

    Job OverviewPosition: Full-Time Technical Content StrategistCompany Overview: DigitalCM LLC is at the forefront of immersive technology, committed to advancing virtual and augmented reality experiences. Our dedicated team is focused on developing innovative solutions that redefine digital content interaction.Role Summary: We are in search of a skilled...

  • Lead Clinical Content Strategist

    2 weeks ago

    Tampa, Florida, United States Apixio Full time

    Job OverviewCompany Background:Apixio operates at the crucial junction of health plans and healthcare providers, innovating a premier Connected Care platform aimed at reducing reimbursement discrepancies while ensuring high-quality patient care. Our mission is to facilitate the transition towards value-based reimbursement models through a combination of...

  • Lead Clinical Content Strategist

    2 weeks ago

    Tampa, Florida, United States Apixio Full time

    Job OverviewCompany Background:Apixio operates at the crucial intersection of health plans and healthcare providers, striving to develop a premier Connected Care platform aimed at reducing reimbursement discrepancies while promoting high-quality patient care. Our mission is to facilitate the transition towards value-based reimbursement models through...

  • Tiktok Content Producer and Strategist

    2 months ago

    Tampa, Florida, United States Lavu, Inc. Full time

    OverviewLavu is looking for a Tiktok Content Producer and Strategist to join our growing marketing teamLavu is a leading, global provider of restaurant point of sale (POS) systems and payment processing designed to help restaurants streamline their operations, improve customer service, and increase profitability. Our innovative software and hardware...

  • Lead Accounting Strategist

    2 weeks ago

    Tampa, Florida, United States Zenith American Full time

    Position OverviewTitle: Lead Accounting Strategist Department: Finance & AccountingBargaining Unit: NBU Grade: N/APosition Type: Exempt Hours per Week: 40Role SummaryThe Lead Accounting Strategist is a highly qualified professional tasked with overseeing intricate accounting operations for a rapidly expanding national organization. In addition to managing...

  • Lead Accounting Strategist

    2 weeks ago

    Tampa, Florida, United States Zenith American Full time

    Position Title: Lead Accounting Strategist Department: Finance & Accounting Bargaining Unit: NBU Grade: N/A Position Type: Exempt Hours per Week: 40 Position Overview The Lead Accounting Strategist is a highly qualified professional, tasked with overseeing intricate accounting operations for a rapidly expanding national organization. In addition to managing...

  • Lead Technical Program Strategist

    2 weeks ago

    Tampa, Florida, United States Frontier Full time

    Position OverviewLead Technical Program StrategistAs a prominent fiber service provider in the United States, we are committed to delivering high-speed broadband solutions that empower countless individuals and enterprises. At Frontier, you will contribute to our mission of constructing a Gigabit America—developing the digital framework essential for our...

  • Lead Cloud Engineering Strategist

    2 weeks ago

    Tampa, Florida, United States Seacoast Bank Full time

    Position: Lead Cloud Engineering Strategist at Seacoast BankSeacoast Bank is seeking a skilled Lead Cloud Engineering Strategist to guide their cloud infrastructure division. The successful candidate will be responsible for the architecture, execution, and oversight of the Microsoft 365 and Azure hosting environments. This position demands a deep...

  • Lead Technical Program Strategist

    2 weeks ago

    Tampa, Florida, United States Frontier, Inc. Full time

    Lead Technical Program Strategist At Frontier, we have a legacy of over 80 years in connecting communities through advanced communication technologies. We are in the midst of a transformation, pioneering new paths in the digital landscape across the nation. We are expanding our workforce to explore and unlock new opportunities. Here, you will have the chance...

  • Lead Technical Program Strategist

    2 weeks ago

    Tampa, Florida, United States Frontier Corporation Full time

    Job OverviewPosition SummaryLead Technical Program StrategistAs a prominent fiber optic service provider in the United States, we are committed to delivering high-speed broadband connectivity that empowers millions of individuals and enterprises. By joining Frontier Corporation, you will contribute to our mission of constructing a Gigabit America,...

  • C14 Lead Audit Strategist

    2 weeks ago

    Tampa, Florida, United States Citigroup Inc Full time

    The Lead Audit Strategist is a pivotal management role responsible for overseeing a sophisticated and essential division within Internal Audit, in collaboration with the Audit team. The primary aim of this position is to formulate and implement a comprehensive Audit Plan, while directing intricate audit operations for a segment of the organization at a...

  • Proposal Strategist

    5 days ago

    Tampa, Florida, United States Cherry Bekaert Full time

    About the RoleWe are seeking a highly skilled Proposal Strategist to join our team at Cherry Bekaert. As a key member of our proposal team, you will be responsible for managing and executing the proposal process for complex Assurance, Tax, and Advisory engagements.Key ResponsibilitiesManage multiple proposals simultaneously, ensuring timely and compliant...

  • Lead Operations Strategist

    2 weeks ago

    Tampa, Florida, United States Mac Papers and Packaging Full time

    Position Overview:As a Lead Operations Strategist, you will be accountable for managing all facets of a branch distribution center's operations. Your primary focus will be on enhancing branch performance, productivity, efficiency, and profitability while leading a team of managers, supervisors, and other direct reports. Key Responsibilities: - Optimize...

  • Lead Environmental Project Strategist

    5 days ago

    Tampa, Florida, United States NxT Level Full time

    Position OverviewAt NxT Level, we are a collaborative team dedicated to providing top-tier environmental consulting and engineering services. Our mission is to deliver innovative solutions that address the complex challenges faced by our clients in both the public and private sectors. With decades of experience, we have successfully managed a variety of...

  • Lead Audit Strategist

    2 weeks ago

    Tampa, Florida, United States Citigroup Inc Full time

    Position OverviewThe Lead Audit Strategist is responsible for overseeing the timely production of intricate, high-quality assurance and audit documentation for a diverse range of business operations, ensuring compliance with the standards set forth by Citigroup and its subsidiaries, as well as regulatory bodies worldwide.This senior management role is...

  • Director, Personal Insurance Campaigns Strategist

    5 days ago

    Tampa, Florida, United States Baldwin Risk Partners Full time

    As a key member of the Personal Lines Marketing team at Baldwin Risk Partners, the Director, Personal Insurance Campaigns Strategist plays a crucial role in creating and launching multi-channel campaigns that drive business growth. This individual works closely with the team and key stakeholders to develop and execute campaigns that target Personal Insurance...

  • Lead Generation Strategist

    1 week ago

    Tampa, Florida, United States Vector Solutions Full time

    Position Overview:Vector Solutions is at the forefront of delivering specialized SaaS solutions that seamlessly integrate content with technology. Our innovative product suite is designed for training and learning management, compliance, workforce scheduling, safety oversight, and more.Our Mission:We strive to empower everyday heroes across public,...

  • Lead Sales Strategist

    2 weeks ago

    Tampa, Florida, United States RFX, LLC Full time

    Position OverviewCompensation: Salary is negotiable based on experience and existing client portfolio, with unlimited commission potential.About RFX, LLCFor over 70 years, RFX/REFE has been a leader in delivering exceptional customer service within the logistics and supply chain sector. As a third-party logistics provider with asset-based capabilities, we...

  • Lead Wealth Management Strategist

    1 week ago

    Tampa, Florida, United States PNC Financial Services Group Full time

    Position Overview At PNC Financial Services Group, our workforce is our most significant asset and competitive edge in the sectors we operate. We are committed to providing an exceptional experience for our clients. Each day, we collaborate to cultivate an inclusive workplace culture where every employee feels respected, valued, and empowered to contribute...

  • Risk Adjustment Market Strategist

    5 days ago

    Tampa, Florida, United States Centene Corporation Full time

    Job SummaryCentene Corporation is seeking a highly skilled Risk Adjustment Market Strategist to join our team. As a key member of our Risk Adjustment prospective team, you will play a critical role in developing and executing the risk adjustment prospective strategy for assigned markets.Key ResponsibilitiesDevelop and execute the risk adjustment prospective...