The Edit Configuration Analyst I performs research on editing concepts and analyzes related claims data, applying coding standards, industry knowledge, and federal regulations to ensure correct billing practices. The role prepares clear, concise findings for internal teams, including Physician and Senior Leadership teams, and supports research, analytics, testing, and claim recommendations.
Key responsibilities include:
- Review and analyze billing for medical appropriateness and charges
- Research and interpret coding and billing standards
- Prepare clear, concise findings and detailed, accurate documents
- Assist with internal claim recommendations
- Communicate research and analytics results
- Assist with clinical education of staff
- Monitor and summarize trends and regulatory changes
- Partner with management to drive department goals
- Collaborate across disciplines and departments
- Ensure compliance with HIPAA regulations and requirements
- Work evening or weekend hours as needed
This is a high-risk role due to exposure to PHI sensitive data.
Requirements & Qualifications
Required qualifications:
- 2 years of experience with inpatient/outpatient medical procedure coding and billing, including medical insurance billing, medical insurance auditing, line-item review, appeals, and reimbursement using the UB-04 form and/or CMS 1500
- 2 years of experience using coding guidelines and resources such as NCCI, CPT, ICD-10, HCPCS, RBRVS, Medicare, Medicaid, other payors, and specialty societies
- 2 years of experience reading and abstracting medical codes from medical records
- 1 year of experience in data mining/data modeling, medical claim analytics preferred, or testing (QA or UAT), claim edit testing preferred
- Basic SQL knowledge for RA and UAT work
- Intermediate to proficient Microsoft Excel and Word skills
- Required licensures, professional certifications, and/or board certifications as applicable
- Ability to work in a standard office environment with extended monitor viewing and use of office equipment
Benefits & Perks
Benefits and perks include:
- Medical, dental, and vision coverage with low deductible and copay
- Life insurance
- Short- and long-term disability
- Paid parental leave
- 401(k) with match
- Employee stock purchase plan
- Generous paid time off based on years of service
- 10 paid company holidays
- Tuition reimbursement
- Flexible spending account
- Employee assistance program
- Sick time benefits
- Incentive bonus program
- Recognition and awards programs
- Flexible schedules whenever possible
- Professional development and educational programs
Location
N/A
Employment Type
Full-time
Experience Level
Associate
Salary Range
$80,000 - $80,000
Remote work allowed
No
Posted
2 weeks ago
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