Claritev is seeking an Edit Configuration Analyst I to research editing concepts and analyze claims data using coding standards, industry knowledge, and federal regulations. The role supports correct billing practices through research, analytics, testing, and clear presentation of findings to internal leadership and cross-functional teams.
Key responsibilities include reviewing billing for medical appropriateness, interpreting coding and billing standards, preparing accurate documentation, assisting with claim recommendations, supporting clinical education, monitoring trends and regulatory changes, and collaborating across departments. This is a high-risk role due to exposure to PHI and requires compliance with HIPAA requirements.
- 2 years of experience with inpatient/outpatient medical procedure coding and billing, including medical insurance billing, auditing, line-item review, appeals, and reimbursement using UB-04 and/or CMS-1500 forms
- 2 years of experience with 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, or claim edit testing/QA/UAT 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 and use a keyboard, copier, telephone, and monitors for extended periods
- 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
- 10 paid company holidays
- Tuition reimbursement
- Flexible spending account
- Employee assistance program
- Sick time benefits
- Bonus opportunity
- Flexible schedules when possible
- Professional development and educational programs
Location
N/A
Employment Type
Full-time
Experience Level
Intermediate Level
Salary Range
$80,000 - $80,000
Remote work allowed
Yes
Posted
1 month ago