Medical Coder - Edit Configuration Analyst

Claritev•New York, NY

6d•Onsite

About The Position

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. In this role, the incumbent will perform research, analytics, and/or testing and present clear, concise, and legible findings to internal teams including Physician and Senior Leadership teams.

Requirements

Two (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 utilizing the UB-04 form and/or CMS 1500.
Two (2) years of experience utilizing coding guidelines and resources including NCCI, CPT, ICD-10, HCPCS, RBRVS, Medicare, Medicaid, other payors and specialty societies.
Two (2) years of experience reading and abstracting medical codes from medical records.
One (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 (RA & UAT).
Intermediate to proficient Microsoft Excel and Word skills.
Required licensures, professional certifications, and/or Board certifications as applicable.
Individual in this position must be able to work in a standard office environment which requires sitting and viewing monitors for extended periods of time, operating standard office equipment such as, but not limited to, a keyboard, copier and telephone.

Nice To Haves

medical claim analytics preferred
claim edit testing preferred

Responsibilities

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.
Demonstrate commitment to core values.
Please note due to the exposure of PHI sensitive data this role is considered to be a High Risk Role.
Perform other duties as necessary.
Communicate across disciplines and departments.
Ensure compliance with HIPAA regulations and requirements.
Demonstrate Company’s Core Competencies and values held within.
Please note due to the exposure of PHI sensitive data this role is considered to be a High Risk Role.
The position responsibilities outlined above are in no way to be construed as all encompassing. Other duties, responsibilities, and qualifications may be required and/or assigned as necessary.

Benefits

health insurance
401k
bonus opportunity
Medical, dental and vision coverage with low deductible & copay
Life insurance
Short and long-term disability
Paid Parental Leave
401(k) + match
Employee Stock Purchase Plan
Generous Paid Time Off – accrued based on years of service
WA Candidates: the accrual rate is 4.61 hours every other week for the first two years of tenure before increasing with additional years of service
10 paid company holidays
Tuition reimbursement
Flexible Spending Account
Employee Assistance Program
Sick time benefits – for eligible employees, one hour of sick time for every 30 hours worked, up to a maximum accrual of 40 hours per calendar year, unless the laws of the state in which the employee is located provide for more generous sick time benefits