Medical Coding Analyst - Edit Configuration UAT

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!!!

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.).

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/outpatient hospital billing including UB-04s, revenue codes, itemization of charges, CPT codes, HCPCS codes, ICD-10 diagnoses and procedure codes, DRG, APCs.
• Knowledge of payer reimbursement policies, state and federal regulations, medical necessity criteria and applicable industry standards.
• Knowledge of commonly used medical data resources such as MDR, Medical Fees in the US, etc.
• Auditing and health information management experience in a healthcare setting preferred.
• Required licensures, professional certifications, and/or Board certifications as applicable.
• Experience with professional and facility contract interpretation.
• Excellent communication (written, verbal and listening), interpersonal, organizational, time-management, analytical, problem-solving, troubleshooting, customer service skills.
• Ability to develop educational materials and job aids pertaining to coding and claims.
• Ability to work evening or weekend hours as needed to meet deadlines.
• Ability to handle multiple tasks in a fast-paced environment.
• Ability to meet individual and team goals, deadlines and work standards.
• Ability to apply independent judgment and determine appropriate course of action.
• Ability to read and abstract medical records.
• Knowledge of medical terminology, anatomy, and physiology.
• Ability to interact and discuss results with providers.
• Ability to lead, teach, mentor others, and facilitate a learning environment.
• 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.

The salary range for this position is $60-70K. 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.

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
• Employee Stock Purchase Plan
• Generous Paid Time Off – accrued based on years of service
  • 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
• 10 paid company holidays
• Tuition reimbursement
• Employee Assistance Program
• 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

EEO STATEMENT

Claritev is an Equal Opportunity Employer and complies with all applicable laws and regulations. Qualified applicants will receive consideration for employment without regard to age, race, color, religion, gender, sexual orientation, gender identity, national origin, disability or protected veteran status. If you would like more information on your EEO rights under the law, please click here.

APPLICATION DEADLINE

We will generally accept applications for at least 15 calendar days from the posting date or as long as the job remains posted.