Apixio is hiring a
Clinical Content Lead

Summary

Join our team as a Clinical Content Lead and contribute to the development and management of our clinical solutions, including Readmissions, Place of Service, Level of Care, and APR-DRG validation clinical concepts. As a key member of our team, you will be responsible for developing content, tracking performance, providing implementation and client support, conducting research, and reviewing claims as needed for proof of concepts.

Requirements

• Bachelor’s degree (health administration, business, nursing)
• Equivalent experience of 5+ years in healthcare billing and coding
• Equivalent experience of 3+ years in claims auditing and recovery auditing

Responsibilities

• Develop innovative strategies to enhance claim selection processes
• Leverages data analysis expertise and strong organizational skills to innovate and optimize proprietary tools
• Utilizes a comprehensive understanding of claim selection methods to refine and execute methodologies that enhance claim selection strategies, particularly focused on inpatient claims
• Enhance and Review Clinical Solutions: Utilize expertise to assist in the enhancement and review of readmissions, place of service, and other clinical solutions
• Collaborative Development: Work with a multi-disciplinary team of programmers, operations staff, product leaders, and auditors to bring DRG process ideas from creation to implementation
• Regulatory Monitoring: Assess and adjust written rules by monitoring their effectiveness, keeping up with regulatory updates, and making necessary changes
• Performance Monitoring: Monitor performance of current and new concepts and continue to adjust to enhance performance and output
• Analytical Problem-Solving: Demonstrate analytical skills to identify problems and trends, develop solutions, and implement action plans
• Policy and Process Development: Develop departmental policies, processes, and training standards
• Support and Evidence: Provide internal and external partners with evidence and references supporting industry standards, auditing guidelines, and review stances
• Solution Development: Collaborate with a multi-disciplinary team to suggest solution development, including operations, product, data analytics, and technology
• Timeline Management: Set timelines and ensure communication on progress, tracking delivery, and escalating roadblocks or dependencies
• Program Deployment: Design and deploy effective programs/solutions to identify and correct claims with aberrant results, providing feedback to resolve root causes
• Research and Special Projects: Assist with research, special projects, and ad hoc claim reviews as needed
• Proof of Concept Assistance: When necessary, provide review support for proof of concepts or sales support

Benefits

• Competitive compensation
• Exceptional benefits, including medical, dental and vision, FSA
• 401k with company matching up to 4%
• Generous vacation policy
• Remote-first & hybrid work philosophies
• A hybrid work schedule (2 days in office & 3 days work from home)
• Modern open office in beautiful San Mateo, CA; Los Angeles, CA; San Diego, CA; Austin, TX and Dallas, TX
• Subsidized gym membership
• Catered, free lunches
• Parties, picnics, and wine-downs
• Free parking