Edit Configuration Analyst

Summary

Claritev helps make healthcare more transparent and affordable through data, technology, and expertise. The Edit Configuration Analyst I researches editing concepts, analyzes medical claims data, applies coding standards and regulations, and communicates findings to internal teams. The role also supports claim recommendations, testing, clinical education, compliance, and trend monitoring.

Responsibilities

• Review and analyze billing for medical appropriateness and charges
• Research and interpret coding and billing standards
• Prepare clear and concise findings
• Produce detailed, accurate documents
• Assist with internal claim recommendations
• Communicate research and analytics results
• Assist with clinical education of staff
• Monitor and summarize trends and regulatory changes
• Partner with management to drive department goals
• Work evening or weekend hours as needed
• Collaborate across disciplines and departments
• Demonstrate commitment to core values
• Note the role's high-risk nature due to PHI exposure
• Perform other duties as necessary
• Communicate across disciplines and departments
• Ensure compliance with HIPAA regulations and requirements
• Demonstrate Company’s Core Competencies and values held within
• Please note due to the exposure of PHI sensitive data – this role is considered to be a High Risk Role
• 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

Skills

• • 2 years' 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 nd or CMS 1500
• • 2 years' experience in utilizing coding guidelines and resources including NCCI, CPT, ICD 10, HCPCs, RBRVs, Medicare, Medicaid, other payors and specialty societies
• • 2 years' experience in reading and abstracting medical codes from medical records
• • 1 year experience in data mining/data modeling, medical claim analytics
• • OR testing (QA or UAT), claim edit testing preferred
• • Basic SQL (RA & UAT)
• • Intermediate/ Proficent Excel & Word
• • 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 monitor(s) for extended periods of time, operating standard office equipment such as, but not limited to, a keyboard, copier and telephone
• Medical claim analytics preferred
• Claim edit testing preferred

Qualifications

Must Haves

• • 2 years' 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 nd or CMS 1500
• • 2 years' experience in utilizing coding guidelines and resources including NCCI, CPT, ICD 10, HCPCs, RBRVs, Medicare, Medicaid, other payors and specialty societies
• • 2 years' experience in reading and abstracting medical codes from medical records
• • 1 year experience in data mining/data modeling, medical claim analytics
• • OR testing (QA or UAT), claim edit testing preferred
• • Basic SQL (RA & UAT)
• • Intermediate/ Proficent Excel & Word
• • 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 monitor(s) for extended periods of time, operating standard office equipment such as, but not limited to, a keyboard, copier and telephone

Nice to Haves

• medical claim analytics preferred
• claim edit testing preferred

Benefits

• This position is also eligible for health insurance, 401k and bonus opportunity.
• Medical, dental, and vision coverage
• Life and disability coverage
• 401(k) with company match
• Employee stock purchase plan
• Flexible spending accounts and health savings accounts
• Paid parental leave
• Mental health resources
• Tuition reimbursement
• Financial planning resources
• Professional development opportunities