Job title: Data Scientist
- Manage and optimize processes for data intake, validation, mining and engineering as well as modeling, visualization and communication deliverables.
- Examine, interpret and report results of analytical initiatives to stakeholders in leadership, technology, sales, marketing and product teams.
In general the main responsibility of this role is to drive business efficiency by supporting the business rules analysis and Revenue Cycle Management operations by identifying the data trends and building the necessary models to aid the identification and implementation of business, medical, coding or process automation rules through the continuous assessment and analysis of denied claims, review of market practice and denial trends, reference checks against international best practice in terms of clinical pathways and medical coding guidelines, as well as review and maintenance of payer protocols. Thereby increasing operational and overall business efficiency.
The role will be responsible for extracting value from the millions of healthcare records to focus on the following areas of technology driven automation and business rules validation through:
- Machine learning to identify opportunities to business develop rules that can either reduce risk of claim rejections or drive revenue optimization
- Predictive modelling concepts to related historical claims denial trends to define future claims management validation and automation processes
- Natural Language Processing techniques to identify and predict relationships between medical records and diagnosis and/or procedures performed
- Lead cross-functional projects using advanced data modeling and analysis techniques to discover insights that will guide strategic decisions and uncover optimization opportunities.
- Build, develop and maintain data models, reporting systems, data automation systems, dashboards and performance metrics support that support key business decisions.
- Design and build technical processes to address business issues.
- Oversee the design and delivery of reports and insights that analyze business functions and key operations and performance metrics.
- Ensure accuracy of data and deliverables of reporting employees with comprehensive policies and processes.
A] Professional Qualifications:
1. Bachelors of Computer Science/Data Management a must.
2. Post graduate studies in Data Analytics or Artificial Intelligence related fields highly desired.
3. Medical Billing/Coding Experience/Certifications exposure preferred.
4. Any additional professional certifications in line with the role will be an added advantage.
B] Technical Knowledge & Experience:
1. 5+ years ’of work experience in healthcare big data projects, out of which 2 years in a senior level role is a must.
- Experience or exposure to Healthcare Medical Billing Claims Management is preferred and must be conversant with the following concepts:
Natural Language Processing, Machine learning, Conceptual modelling, Statistical analysis, Predictive modelling, Hypothesis testing. -experience working on building an AI Conversation Voice Chatbot, NLP, NLU, Multilingual, Speech Recognition, Text to Speech and Speech to Text Conversion. – ANN, CNN, RNN, deep learning Preferably in Digital Health startup to solve the specific complex problem. * Needs to have statistical, mathematical, predictive modeling as well as business strategy skills to build the algorithms necessary to ask the right questions and find the right answers.
- Need to understand how the products are developed and even more important, as big data touches the privacy of consumers, they need to have a set of ethical responsibilities.
- Good knowledge & experience in Artificial Neural Network (ANN ), AI conversational Chatbot & Needs to be able to write the required Algorithm and coding programming.
3. Experience in hospital operations and a general understanding of revenue cycle with an emphasis on billing, coding and charge capture desirable.
4. Familiarity with Rule Edits or Business Rules Management Systems technologies and tools is an advantage.
5. Knowledge of medical terminology, CPT, HCPCS, ICD-9/10, CDM and contract management. Medical Coding certifications is an added advantage. Preferably in different programming languages such as Python, Tensor Flow, Keras, AWS (ML and DL), Numpy, Pytorch.
Job date: Fri, 07 Jan 2022 23:24:05 GMT
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