<p>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.</p> <p>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!!!</p> <p>The Edit Configuration Coding Analyst 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, incumbent will perform analytics and present clear, concise, legible findings to internal teams including Physician & Senior Leadership teams.</p> <p>JOB ROLES AND RESPONSIBILITIES:</p> <ul> <li>Review and analyze complex inpatient, outpatient, and practitioner billing for opportunities to edit claims based on various industry guidelines; analyze charges of various revenue centers with consideration to patient diagnosis, procedures, age and facility type including any additional information perceived as potentially helpful in the payment integrity and/or negotiation process. </li><li>Research concepts and analyze data using analytics tools such as SQL. </li><li>Prepare clear, concise, and legible findings </li><li>Present findings and data associated with assigned tasks to various internal groups including Client, Physician, & Senior Leadership. </li><li>Drive successful coding operations through the application of learned, certified knowledge in addition to continuous professional development and ongoing coding research. </li><li>Provide general support to clinical team members, serving as a resource and subject matter expert (SME). </li><li>Monitors turnaround times and provides suggestions for process efficiencies. </li><li>Uses independent decision-making skills. </li><li>Collaborate with physician and analytics teams to create, enhance or suggest new coding edits, claim factors, guidelines and other applicable reference materials. </li><li>Monitor, research, and summarize trends, coding practices, and regulatory changes. </li><li>Apply clinical judgment and high level of expertise along with analytic skills in review of the most challenging and difficult cases; including conducting additional research as needed. </li><li>Communicates clinical, coding and reimbursement findings to co-workers and management in a clear, organized manner. </li><li>Assist with education of staff as it relates to claims, suggest additional negotiation talking points or tools, develop instructional design, when applicable and communicate overall industry or regulatory changes which affect the department. </li><li>Partner with management to drive department goals and objectives. </li><li>Collaborate, coordinate, and communicate across disciplines and departments. </li><li>Ensure compliance with HIPAA regulations and requirements. </li><li>Demonstrate commitment to the Company's core values. </li><li>Please note due to the exposure of PHI sensitive data -- this role is considered to be a High-Risk Role. </li><li>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. </li></ul> <p>JOB SCOPE:</p> <p>This position works independently with minimal supervision in order to complete the outlined responsibilities. The incumbent balances several projects at a time and work is varied and complex. More complex issues are referred to higher levels. The incumbent follows established procedures and uses knowledge of the Company's general business principles, industry dynamics, market trends, and specific operational details when performing all aspects of the job.</p> <p>The salary range for this position is $60K- 70K. 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</p> <p>BENEFITS</p> <p>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.</p> <p>Your benefits will include:</p> <ul> <li> <p>Medical (PPO & HDHP), dental and vision coverage</p> </li><li> <p>Pre-tax Savings Account (FSA & HSA)</p> </li><li> <p>Life & Disability Insurance</p> </li><li> <p>Paid Parental Leave</p> </li><li> <p>401(k) company match</p> </li><li> <p>Employee Stock Purchase Plan</p> </li><li> <p>Generous Paid Time Off - accrued based on years of service</p> </li><li> <p>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</p> </li><li> <p>10 paid company holidays</p> </li><li> <p>Tuition reimbursement</p> </li><li> <p>Employee Assistance Program</p> </li><li> <p>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</p> </li></ul> <p>#LI-SW1</p> <p>JOB REQUIREMENTS (Education, Experience, and Training):</p> <ul> <li>Bachelor's degree, preferred. </li><li>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. </li><li>Minimum 5 years' experience in healthcare (direct patient care, medical billing, claims editing, etc) </li><li>Minimum 5 years' experience in medical coding (medical insurance auditing, line-item review, audits, coding, and/or reimbursement). </li><li>2 years' experience in data mining/data modeling; experience within claim analytics preferred. </li><li>Basic SQL proficiency required; Intermediate proficiency preferred. </li><li>Intermediate Excel proficiency required. </li><li>Intermediate proficiency using other MS Office Suite applications (Word, Outlook and PowerPoint) required. </li><li>Basic to intermediate Visio proficiency helpful. </li><li>Extensive knowledge of inpatient/outpatient hospital billing including UB-04s, revenue codes, itemization of charges, CPT codes, HCPCS codes, ICD-10 diagnoses and procedure codes, DRG, APCs. </li><li>Knowledge of payer reimbursement policies, state and federal regulations, medical necessity criteria and applicable industry standards. </li><li>Knowledge of commonly used medical data resources such as MDR, Medical Fees in the US, etc. </li><li>Auditing and health information management experience in a healthcare setting preferred. </li><li>Required licensures, professional certifications, and/or Board certifications as applicable. </li><li>Experience with professional and facility contract interpretation. </li><li>Excellent communication (written, verbal and listening), interpersonal, organizational, time-management, analytical, problem-solving, troubleshooting, customer service skills. </li><li>Ability to develop educational materials and job aids pertaining to coding and claims. </li><li>Ability to work evening or weekend hours as needed to meet deadlines. </li><li>Ability to handle multiple tasks in a fast-paced environment. </li><li>Ability to meet individual and team goals, deadlines and work standards. </li><li>Ability to apply independent judgment and determine appropriate course of action. </li><li>Ability to read and abstract medical records. </li><li>Knowledge of medical terminology, anatomy, and physiology. </li><li>Ability to interact and discuss results with providers. </li><li>Ability to lead, teach, mentor others, and facilitate a learning environment. </li><li>Individual in this position must be able to work in a standard office environment which requires sitting and viewing monitor(s) for extended periods of time, operating standard office equipment such as, but not limited to, a keyboard, copier and telephone. </li></ul> <p>BENEFITS</p> <p>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.</p> <p>Your benefits will include:</p> <ul> <li>Medical, dental and vision coverage (low copay & deductible) </li><li>Life insurance </li><li>Short and long-term disability </li><li>401(k) + match </li><li>Generous Paid Time Off </li><li>Paid company holidays </li><li>Tuition reimbursement </li><li>Flexible Spending Account </li><li>Employee Assistance Program </li><li>Summer Hours </li></ul>