Senior Payment Integrity Data Consultant

Elevance Health•Indianapolis, IN

1d•Hybrid

About The Position

The Senior Payment Integrity Data Consultant (Business Information Developer Consultant Senior) is viewed as an expert in the development and execution of data mining analyses. This position is focused on spending time thinking about programming and how it would be used to design solutions. This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Alternate locations may be considered if candidates reside within a commuting distance from an office. Candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.

Requirements

Requires a BS/BA degree; minimum of 6 years experience; or any combination of education and experience, which would provide an equivalent background.
Expert level PC, spreadsheet, and database skills, as well as experience in standard Business Information tools and programming/query languages.
Billing, coding, revenue cycle, and claims editing software experience, required.
Experience in claims adjudication and application of NCCI editing and claims payment rules.
Ability to interpret claim edit rules and references.
Ability to apply industry coding guidelines to claim processes.
Proven experience reviewing, analyzing, and researching coding issues for payment integrity.
Logic skills: ability to break policy edits down into decision making paths.
Ability to troubleshoot and apply root-cause analysis of logics not functioning as intended.
Strong ideation skills.

Nice To Haves

The ability to communicate effectively with multiple levels within the organization is strongly preferred.
5+ years of claims editing experience with healthcare payers and/or claims editing software vendors, strongly preferred.
Nationally recognized coding or billing credential preferred: CCS, CCS-P, CPC, CPB, CIC.

Responsibilities

Develops very complex and varied strategic report applications from a Data Warehouse.
Establishes and communicates common goals and direction for the team.
Establishes and maintains advanced knowledge of data warehouse database design, data definitions, system capabilities, and data integrity issues.
Acts as a source of direction, training and guidance for less experienced staff.
Monitors project schedules and costs for own and other projects.
Develops and supports very complex Data Warehouse-related applications for business areas requiring design and implementation of database tables.
Conducts training on the use of applications developed.