Medical Coder - Edit Configuration Analyst

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 towards becoming a leading technology, data, and innovation voice in healthcare. Onward and Upward!!!

JOB SUMMARY

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.

DUTIES

1. Review and analyze billing for medical appropriateness and charges.
2. Research and interpret coding and billing standards.
3. Prepare clear and concise findings.
4. Produce detailed, accurate documents.
5. Assist with internal claim recommendations.
6. Communicate research and analytics results.
7. Assist with clinical education of staff.
8. Monitor and summarize trends and regulatory changes.
9. Partner with management to drive department goals.
10. Work evening or weekend hours as needed.
11. Collaborate across disciplines and departments.
12. Demonstrate commitment to core values.
13. Please note due to the exposure of PHI sensitive data this role is considered to be a High Risk Role.
14. Perform other duties as necessary.
15. Communicate across disciplines and departments.
16. Ensure compliance with HIPAA regulations and requirements.
17. Demonstrate Company’s Core Competencies and values held within.
18. Please note due to the exposure of PHI sensitive data this role is considered to be a High Risk Role.
19. 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.

COMPENSATION

The salary for this position is $80,000 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.

Qualifications

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.

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, 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