Algorithm Methodologist

HWT, Inc., (www.hwtc.com) is a successful, high-growth healthcare technology & services company, helping large public sector payers to implement revenue recovery programs, conduct data-intensive audits and perform high ROI specialty data analytics.

HWT is seeking a highly motivated, organized and professional Algorithm Methodologist (AM) for its Portland Maine office, responsible for performing health care claims analysis to identify overpayments related to fraud, waste, abuse, and inappropriate utilization of health care services. The AM is responsible for providing leadership to the pharmacy algorithm group staff; developing and modifying algorithms based on research; conducting analysis including analysis of Medicaid and Medicare policy; analyzing prescriptions and medical records to respond to providers' request for informal review/appeals; and conducting quality assurance and review of algorithms created by pharmacy algorithm group staff and providing subject matter expertise. The AM travels nationally for meetings with clients and attend conferences.

Qualified applicants will have a Master's degree in a health care related field plus documented experience performing health care data claims analysis focusing on pharmaceutical data and involving Medicaid, Medicare and other medical insurance, as well as developing and maintaining algorithms to identify patterns of fraud, waste, abuse and overpayment of healthcare services. Please send resume and salary requirements to jcain@hwtc.com or HWT, Inc. 2 Monument Square, 4th Floor, Portland, ME 04101, Attention: John Cain. NO PHONE CALLS PLEASE. EOE.

Posted on: 8/11/05