Medical Coding Analyst - Edit Configuration UAT

Imagine a workplace that encourages you to interpret, innovate and inspire. Our employees do just that by helping healthcare payers manage the cost of care, improve competitiveness and inspire positive change. You can be part of an established company that helps our customers thrive by interpreting our client's needs and tailoring innovative cost management solutions.

 

We are MultiPlan and we are where bright people come to shine!

 

The Edit Configuration Coding Analyst UAT performs Quality and User Acceptance Testing for enhancements to Claims Editing/Payment Integrity product offerings – applying coding standards, industry knowledge and federal regulations to ensure correct billing practices. In this role, incumbent will perform testing and present clear, concise, legible findings to internal teams including Physician & Senior Leadership teams.

 

JOB ROLES AND RESPONSIBILITIES:

1. Manage and track assigned department workload re-distributing and escalating to leadership as necessary.
2. Create and complete robust testing procedures to ensure the functionality, integrity, accuracy, and quality of all modifications and enhancements to the editing logic, including:
   • Carefully analyzing clinical and technical requirements to clearly define the scope of testing.
   • Establishing, developing, and maintaining comprehensive test scenarios, data, checklists, and other essential documentation, all aligned with specific requirements.
   • Adopting best practices in software testing methodologies and techniques to guarantee optimal outcomes.
3. Examine and resolve incorrect results, identify the root cause, and recommend solutions.
4. Produce detailed, accurate documents in a consistent format that demonstrate strong analytical and documentation skills.
5. Enhance test-based pre-production validation by effectively using post-production results and team feedback.
6. Provide expert guidance and support to team members, serving as Subject matter Expert (SME)
7. Effectively collaborate, coordinate and communicate across various disciplines and departments throughout the organization to resolve problems and ensure consistency and accuracy.
8. Identify issues, problems, and opportunities, bring suggestions, and implement solutions to improve department's effectiveness and efficiency
9. Complete and oversee special projects assigned by leadership.

1. Monitors turnaround times and provides suggestions for process efficiencies.
2. Participate in the development of policies and procedures based on current and future trends.

1. Collaborate, coordinate, and communicate across disciplines and departments.
2. Ensure compliance with HIPAA regulations and requirements.
3. Demonstrate Company's Core Competencies and values held within.
4. Please note due to the exposure of PHI sensitive data, this role is considered to be a High-Risk Role.
5. 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.

JOB SCOPE:

The incumbent works independently and exercises significant independent judgment. The incumbent will manage staff and help provide thorough and appropriate responses to meet the goals of the department. The incumbent provides input to make critical business decisions, including staffing and process improvement, and impacts day-to-day operations through the oversight of coding reviews and providing direction to staff on individual cases. This is a people management job with authority for all HR actions (hiring, separations, discipline, training, etc.).

Qualifications

JOB REQUIREMENTS (Education, Experience, and Training):

• Bachelor's degree, preferred.
• Current nursing certification, coding credential (CCS, CCS-P or CPC), or Registered Health Information Technician credential (RHIA/RHIT) required and maintained as a condition of employment.
• Minimum 5 years' experience in healthcare (direct patient care, medical billing, claims editing, etc)
• Minimum 5 years’ experience in medical coding (medical insurance auditing, line-item review, audits, coding, and/or reimbursement).
• 2 years’ experience in testing (QA or UAT); experience within claim editing preferred.
• Basic SQL proficiency required; Intermediate proficiency preferred.
• Intermediate Excel proficiency required.
• Intermediate proficiency using other MS Office Suite applications (Word, Outlook and PowerPoint) required.
• Basic to intermediate Visio proficiency helpful.
• Extensive knowledge of inpatient/out