We appreciate your interest in Healthcare Data Management. All positions require the ability to interact well in a team environment and candidates that enjoy working in a small entrepreneurial company. Working knowledge of claims processing systems, claims adjudication, and medical and pharmacy data sets is helpful, but not required of open job positions. The following are the current job opportunities to join a growing company.

All positions are located in King of Prussia, Pennsylvania. Compensation includes salary, health insurance, 401K, and other benefits. If qualified for a position with the opportunity to grow with an exciting dynamic company, please submit your cover letter, resume, and salary requirements to HDM.

Healthcare Data Management seeks a Health Plan Auditor with a strong background and experience in health plan administration, financial auditing, claims auditing, claims processing and payment systems, self-funded companies and third party administrators. This person is responsible for conducting audits of third party administrators on the behalf of clients that are self-insured employer groups.

Responsibilities:
HDM auditors measure administrator performance, evaluate contract compliance, evaluate discounts, audit claims and recover overpayments. The audit provides our clients with assurance of their fiduciary responsibilities, compliance with Sarbanes-Oxley, government auditing standards and measure performance of vendors. HDM auditors initiate a comprehensive onsite review at the third party administrator. The purpose is to evaluate the control environment. During the onsite visit, we assess mail operations, claim processing and check processing. We review internal control policies and procedures and determine if errors or irregularities have occurred or the likelihood of them occurring. Conduct a claim sample audit at third party administrators. The auditor determines the discount arrangement and tests it as the result of the claim audit. The auditor performs a compliance audit of the contract the client has with the administrator, including testing performance guarantees. The auditor is responsible for documenting the onsite audit and developing Draft and Final Audit Reports. The auditor participates in conference calls and meetings with clients and administrators.

Qualifications:
To qualify, you must have at least 10 years experience in health benefits auditing or health plan administration or managing claims processing, as well as strong accounting and financial experience and the ability to perform: ASO Agreement Audits, Operations/Internal Control Audits, Financial Funding Audits, Sample Claim Audits, and Discount Audits. Ability to write comprehensive audit reports, document findings, and communicate analysis in a clear style. It requires the ability to be detail oriented and focused on delivering a quality service. The person must be professional when contacting clients and administrators, have the ability to conduct entrance and exit interviews with administrators and have the ability to interface with corporate executives. Requires computer experience and the ability to use Microsoft Word and Excel. Ability to communicate by e-mail and ability to use the internet. Requires a strong personality with high-energy level and self-confidence, a self-starter, who thrives on contact with people and who enjoys operating in an entrepreneurial environment. Requires problem solving and analytical capabilities, and a desire to offer outstanding customer service. Position requires periodic travel to plan administrators for approximately one week per audit.

HDM Government Services (HDMGS) is seeking talented individuals for auditor positions as part of a program focused on detecting waste, fraud and abuse in the Part C Medicare Advantage and Part D Prescription Drug Program by the Centers for Medicare and Medicaid Services (CMS). We seek individuals that want to be part of an exciting program that helps government-sponsored health plans with managing expenses, ensuring program integrity and providing independent evidence of budget responsibility. With the costs of healthcare and prescription drugs hitting all-time highs, and with continued pressure on management of expenditures, HDMGS offers government-sponsored healthcare programs services that are in demand. HDMGS is affiliated with Healthcare Data Management. To learn more about HDMGS, please visit our website www.hdmgs.com.

Responsibilities:
Auditors will perform desk and onsite audits of Medicare Part C and D plan sponsors with the objective to document compliance with regulations and contractual agreements. The audit program is focused on detecting waste, fraud and abuse with prescription drugs. Auditors are responsible for documenting the audits and developing audit reports. Auditors participate in conference calls and meetings with plans. Auditors will be required to travel in order to perform onsite audits at the plans.

Qualifications:
Auditors should have a bachelor’s degree and backgrounds in health care, accounting/auditing, health plan management, pharmacy technician or pharmacy program management. Ability to write comprehensive audit reports, document findings, and communicate analysis in a clear style. It requires the ability to be detail oriented and focused on delivering a quality service. Must be professional and have the ability to conduct interviews and onsite audits of plans.Requires computer experience working with Microsoft Word and Excel. Ability to communicate by e-mail and ability to use the internet. Requires a strong personality with high-energy level and self-confidence, who thrives on contact with people and who enjoys operating in an entrepreneurial environment. Requires problem solving and analytical capabilities, and a desire to offer outstanding customer service. Auditors will be part of a federal contract and therefore a background check and drug screening is required. Any offer made by HDM to a candidate is contingent on passing a background check and drug screening. HDM will arrange and pay for the check and screening.