Edit Configuration Analyst - Research Analytics

Edit Configuration Analyst I- Research Analytics

 

At Claritev, we pride ourselves on being a dynamic team of innovative professionals. Our purpose is simple - we strive to bend the cost curve in healthcare for all. Our dedication to service excellence extends to all our stakeholders, internal and external, driving us to consistently exceed expectations. We are intentionally bold, we foster innovation, we nurture accountability, we champion diversity, and empower each other to illuminate our collective potential.

 

Be part of our amazing transformational journey as we optimize the opportunity toward becoming a leading technology, data, and innovation voice in healthcare. Onward and Upward!

Job Summary

The Edit Configuration Analyst I researches editing concepts and analyzes claims data to support accurate billing practices across healthcare systems. This role applies coding standards, regulatory guidance, and industry knowledge to perform analytics, testing, and research while delivering clear findings to internal teams, physician partners, and senior leadership.

Key Responsibilities

• Review and analyze medical billing for accuracy, medical appropriateness, and correct charges
• Research and interpret coding standards and billing guidelines to ensure compliance
• Conduct claims edit research, analytics, and testing activities
• Prepare clear documentation and communicate findings to internal stakeholders
• Support claim review processes and internal recommendations
• Assist with clinical education initiatives and training materials
• Monitor and summarize industry trends, regulatory updates, and coding changes
• Collaborate with leadership and cross-functional teams to support departmental goals
• Ensure compliance with HIPAA and data security standards due to PHI exposure
• Perform additional duties and responsibilities as assigned

Please note: Due to the exposure to PHI-sensitive data, this role is considered a high-risk role.

Job Scope

This position works independently with minimal supervision to complete assigned responsibilities. The incumbent manages multiple projects simultaneously and performs varied and moderately complex work. More complex issues are escalated to senior team members. The role requires adherence to established procedures while utilizing knowledge of healthcare industry practices, regulatory standards, and operational processes.

 

Qualifications

Requirements

 

Education & Experience

• 2+ years of experience with inpatient and/or outpatient medical procedure coding and billing including insurance billing, auditing, line-item review, appeals, and reimbursement using UB-04 and/or CMS-1500 forms
• 2+ years of experience using coding guidelines and resources including NCCI, CPT, ICD-10, HCPCS, RBRVS, Medicare, Medicaid, and other payer guidelines
• 2+ years of experience reviewing medical records and abstracting medical codes
• 1+ year of experience in data mining, data modeling, medical claims analytics, or claim edit testing (QA or UAT) preferred

Technical Skills

• Basic SQL knowledge preferred (RA & UAT environments)
• Intermediate proficiency with Microsoft Excel and Word
• Relevant professional certifications or licensure as applicable

This position requires the ability to work in a standard office environment including sitting and viewing monitors for extended periods while operating standard office equipment such as a computer, keyboard, copier, and telephone.

Compensation

 

The salary range for this position is $70-75k annually. Specific offers take into account a candidate’s education, experience and skills, as well as the candidate’s work location and internal equity. This position is also eligible for health insurance, 401k and bonus opportunity.

Benefits

We realize that our employees are instrumental to our success, and we reward them accordingly with very competitive compensation and benefits packages, an incentive bonus program, as well as recognition and awards programs. Our work environment is friendly and supportive, and we offer flexible schedules whenever possible, as well as a wide range of live and web-based professional development and educational programs to prepare you for advancement opportunities.

Your benefits will include:

• Medical (PPO & HDHP), dental and vision coverage
• Pre-tax Savings Account (FSA & HSA)
• Life & Disability Insurance
• Paid Parental Leave
• 401(k) company match<