About the role

We are seeking someone with deep exposure to multiple aspects of healthcare (incl. payer and provider) and experience in evaluating data and information quality and creating innovative ways of remediating and addressing these problems. There will be a special emphasis on understanding the context of creation and consumption of healthcare claims data, especially from the claims adjudication and reimbursement process. You will work closely with business leaders and stakeholders holders to identify semantic and clinical constraints and relationships in the underlying data and collaborate with data engineers to check and validate the information quality and data from different sources.

Why join us?

Hop on a rocketship: Included Health has recently become the second-biggest digital health company in the US. We’re on a roll and we are still only in the early innings of our mission.

Accelerate your career: Forbes’ recently named us a Best Startup Employer, and we’ve been voted a Glassdoor Best Places to work, and a 4x Career-Launching Company by Wealthfront.

Roll up your sleeves and partner with experts with all kinds of experience: We hire for intellectual curiosity, humility, and hunger for impact. In this role you’ll get exposure across the company in many strategic projects where you’ll work closely with go-to-market leaders, finance, operations specialists, product managers, doctors, population health experts, designers and data scientists who share a singular goal: make healthcare better.

Make healthcare work for millions of people: We’re taking on healthcare head-on. End each day knowing that your work is transforming a $3.6 trillion industry and millions of people’s lives for the better.

What you'll be doing...

• Develop logic to interpret claims adjudication activity and work with engineers to implement database ingestion rules
• Partner with engineers to develop the capability to ingest EDI claims feeds
• Create standard file specification for transmitting claims-related or claims-derived data to external partners
• Engage with business and clinical stakeholders to acquire and implement clinical and business constraints and relationship for checking data quality
• Identify and implement examples of Information Checking and Quality Enforcement at the point of Data Acquisition
• Develop logic for monitoring and governing claims data quality
• Partner with engineers to implement data validation and alerting for claims data
• Work with business partners in developing trend analyses based on claims data; develop logic to proactively identify inappropriate or outlier claims; and assist in the streamlining the process to resolve claims disputes
• Review existing Information Quality and Analysis tools - e.g., Anomalo and analyze existing capabilities related to data formats and missing values.
• Enhance capabilities for specification and enhancement of information quality criteria. Design and Implement Information Quality Metrics and understand their impact on broader metrics associated with the Data Platform
• Review and record data requirements of various applications and identify the level of data quality that is relevant for a given application

What makes you a great fit...

• (Must Have): Deep exposure and knowledge of clinical, claims and benefit data. Solid background in statistical data analysis.
• (Preferred) Exposure to Terminology Standards such as ICD10, CPT, Snomed, LOINC, RXNorm (Must Have), ERGs, RERGs, DRGs (Nice to Have)
• (Nice to have) Experience with Clinical Information Models - FHIR (Preferred), OMOP, Pcorenet (Nice to Have) Knowledge of the Healthcare Ecosystem and Use Cases - e.g., Care Workflows, Careplans, Prior Auth, Population Health, Segmentation/Stratification, Risk Computation, etc. (Must Have)
• (Preferred) Ability to work with Clinical and Business SMEs and identify clinical and business constraints for data validation and checking

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About Included Health

Included Health is a new kind of healthcare company, delivering integrated virtual care and navigation. We’re on a mission to raise the standard of healthcare for everyone. We break down barriers to provide high-quality care for every person in every community — no matter where they are in their health journey or what type of care they need, from acute to chronic, behavioral to physical. We offer our members care guidance, advocacy, and access to personalized virtual and in-person care for everyday and urgent care, primary care, behavioral health, and specialty care. It’s all included. Learn more at includedhealth.com.

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Included Health is an Equal Opportunity Employer and considers applicants for employment without regard to race, color, religion, sex, orientation, national origin, age, disability, genetics or any other basis forbidden under federal, state, or local law. Included Health considers all qualified applicants in accordance with the San Francisco Fair Chance Ordinance.