[Remote] Edit Configuration Analyst

Note: The job is a remote job and is open to candidates in USA. Claritev is a healthcare data, technology, and expertise company focused on making healthcare more transparent and affordable. The Edit Configuration Analyst I researches editing concepts, analyzes claims data, and applies coding standards, industry knowledge, and federal regulations to support accurate billing practices. The role also conducts research, analytics, and testing and presents findings to internal teams, including physician and senior leadership teams.

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
• 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
• 1 year experience in data mining/data modeling, medical claim analytics preferred; OR testing (QA or UAT), claim edit testing preferred

Benefits

• Remote work arrangement
• Health insurance
• 401(k) with company match
• Bonus opportunity
• Competitive compensation and incentive opportunities (where eligible)
• Medical, dental, and vision coverage
• Life and disability coverage
• Employee stock purchase plan
• Flexible spending accounts and health savings accounts
• Paid time off and company holidays
• Paid parental leave
• Mental health resources
• Tuition reimbursement
• Financial planning resources
• Professional development opportunities
• Meaningful opportunities to grow your career

Company Overview

Company H1B Sponsorship