Claims Editing Analyst Jobs

MUST HAVE EXPERIENCE

• Certified Coder
• Experience with Claims Editing Software
• SQL
• Fully understand Editing Concepts

ESSENTIAL FUNCTIONS OF THE ROLE

• Installs, quality checks, and tests new/existing system configuration, software changes, and new releases/upgrades to ensure the accuracy, completeness and compatibility of changes.
• Creates complex design documents through the assessment of requirements. Assesses alternatives to different designs and chooses best solution to fit business needs. Considers interdepartmental impact when recommending solutions.
• Utilizes system development lifecycle methodology to implement system changes to production environments.
• Monitors existing system functionality and makes recommendations, where appropriate, to maintain acceptable levels of performance, reliability, and end user satisfaction.
• Serves as an internal consultant and subject matter professional by effectively participating on numerous cross-functional teams and projects, as well as troubleshooting inquiries and issues from other departments.
• Ensures the quality and integrity of work requests though the use of production validation and audit strategies.
• Develops, maintains, and disseminates internal and external configuration documentation, including status updates. Prepares procedural and customer documentation when required.
• Configures, tests and documents configuration solutions.
• Maintains assigned subsystem.
• Research complex problems to ascertain possible solutions. Designs and implements solutions to help key business targets, including developing design requirements and technical specifications.

KEY SUCCESS FACTORS

• Working knowledge of CPT-4, ICD-10-CM and general medical terminology.
• Demonstrates a high level of aptitude in utilizing data investigation and query tools such as MS-Access, SQL, and MS-Excel in order to identify root-cause issues.
• Knowledge and expertise of medical benefit policies and plan designs, claims hospital and medical processing, and adjudication with data skills.
• Broad operational managed care background preferred.
• Previous training and documentation experience preferred.
• Exceptional data, problem solving and project management skills.
• Excellent relational skills, including the ability to work with all levels of personnel.
• Able to perform complex business and product requirement study.
• Medical coding and understanding Optum CES, ClaimsXten, Cotiviti experience required.
• CES (Claims Editing System) experience required.