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 involves research, analytics, and testing, with findings presented clearly to internal teams including Physician and Senior Leadership teams.
Responsibilities include:
- Review and analyze billing for medical appropriateness and charges
- Research and interpret coding and billing standards
- Prepare clear and concise findings
- Produce 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
- Work evening or weekend hours as needed
- Collaborate across disciplines and departments
- Ensure compliance with HIPAA regulations and requirements
- Perform other duties as necessary
This is considered a high-risk role due to exposure to PHI sensitive data.
Requirements & Qualifications
- Two 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 UB-04 and/or CMS 1500
- Two years of experience using coding guidelines and resources including NCCI, CPT, ICD-10, HCPCS, RBRVS, Medicare, Medicaid, other payors, and specialty societies
- Two years of experience reading and abstracting medical codes from medical records
- One year of experience in data mining/data modeling, medical claim analytics preferred, or testing (QA or UAT), claim edit testing preferred
- Basic SQL knowledge (RA & UAT)
- 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, including sitting and viewing monitors for extended periods and using standard office equipment
Benefits & Perks
- 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, accrued based on years of service
- 10 paid company holidays
- Tuition reimbursement
- Flexible Spending Account
- Employee Assistance Program
- Sick time benefits for eligible employees
- Flexible schedules whenever possible
- Professional development and educational programs
- Incentive bonus program
- Recognition and awards 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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