Specialist, Complex Clinical Solutions

About Advanced Medical Strategies

AMS is the premiere provider of payment integrity, risk management, and business intelligence solutions that drive smarter, faster, more cost-effective care.

Payment Integrity
Explore cutting-edge solutions that empower your team to automate payment integrity processes, avoid or recover overpayments, and reduce outsourcing costs.

Risk Management
Enhance critical coverage decisions with analytical tools that support >90% of all stop-loss and reinsurance premiums written annually.

Business Intelligence
Strengthen your contracts and policies with powerful predictive analytics, advanced reporting tools, and consultative support.

Overview of the Position:

Reporting to the VP of Complex Clinical Solutions, you will be part of a team responsible for supporting the payment integrity experience for clients utilizing AMS software. The role involves client support, analyzing client data, and ensuring accuracy of technical and clinical information for itemized bill review. It’s a collaborative role that’s pivotal to multiple internal teams as well as external clients.

The Position (Duties and Responsibilities):

·         Provide education and clinical expertise to AMS and clients for the itemized bill review process. Internally, support staff with your knowledge of the payment integrity industry.

·         Support sales and client relations with content preparation, by speaking at industry venues, and by demonstrating the benefits of itemized bill review software products during client-facing presentations.

·         Review policy verbiage to provide feedback to clients, enhance usage of products, and create internal policies related to itemized bill review.

·         Collaborate with IT on enhancements to product features, functionality, and user interface.

·         Utilize your medical knowledge along with internal resources, professional resources, clinical practice guidelines, and subscriber policies to create product content.

·         Perform quality assurance for software development and to ensure positive client outcomes.

·         Utilize your critical thinking abilities to collect, analyze, and evaluate information for additions and changes to the product database.

·         Collaborate and communicate with external clients as well as internal departments such as IT, Client Relations, and Sales to facilitate the design and acceptance of itemized bill review products.

·         Engage in projects that support departmental goals and identify new opportunities for growth and enhancement.

·         Promote a safe and healthy work environment by adhering to organization standards and legal regulations.

Skills and Qualifications:

·         Demonstrate analytical, critical thinking, complex problem solving and decision-making skills

·         Strong time management skills while producing accurate work; ability to adjust priorities as required to accomplish departmental objectives

·         Ability to multi-task and adapt promptly to change

·         Self-directed with the capability of working both independently and as part of a team; strong team and collaborative skills

·         Excellent verbal and written communication skills

·         Strong technology and computer proficiencies including MS Office Suite expertise

·         Insight into software data security and privacy assessments, audit and risk management/mitigation practices, and information security standards

·         Familiarity with (or ability to become familiar with) information security regulations, data protection laws, and auditing frameworks such as HITRUST and HIPAA.

Education, Experience, and Licensing Requirements:

·         Active and unrestricted nursing license

·         Minimum bachelor's degree in nursing

·         4+ years experience as a nurse in a clinical setting

·         2+ years experience working in payment integrity industry with an emphasis on itemized bill review

Nice to Haves (Education, Experience, and Licensing Preferred):

·         Master’s degree in a related field (such as Nursing, Healthcare Administration, etc.)

·         Experience working with healthcare data analytics

Travel and Background Check Requirements:

·         This job requires domestic air travel to locations in the US multiple times per year.

·         FCRA-compliant background checks and E-Verify employment eligibility confirmation are required prior to the start of employment.

Are you a licensed nurse with payment integrity experience and a background in a highly technical and analytical field and ready for an exciting new phase of your career working with a dynamic team supporting the development and enhancement of cutting-edge healthcare software?

Are you able to conceptualize integration of technology into aspects of payment integrity and detail oriented to ensure optimal feedback and results? Can you communicate effectively and have good organization skills for managing multiple duties. You have a collaborative spirit and want to work towards the best outcome for clients and colleagues. APPLY TODAY!

Suggested Pay Range:

The salary range for this position is $115,000 - $130,000 commensurate with experience and education.

Equal Opportunity Statement

AMS is an equal opportunity employer and complies with all applicable federal, state, and local fair employment practices laws. AMS strictly prohibits and does not tolerate discrimination against applicants  because of race, color, religion, creed, national origin or ancestry, ethnicity, sex (including pregnancy), gender (including gender nonconformity, status as a transgender individual, and gender identity), sexual orientation,  age, physical or mental disability, citizenship, past, current, or prospective service in the uniformed services,  genetic information, or any other characteristic protected under applicable federal, state, or local law.

The above statements are intended to describe the general nature and level of work being performed and are not intended as an exhaustive list of all responsibilities, duties, and skills required of the position. Nothing in this document is intended to exclude the opportunity for modifications or adjustment to the job or the manner of performing it consistent with the requirement to provide reasonable accommodations to the disabled. With or without accommodation, the essential functions must be performed. Employees unable to accomplish any functions may request reasonable accommodations pursuant to the Americans with Disability Act.