Concept Development Analyst

Cotiviti US & Canada Page; Myrtle Point (OR); Remote; USD 100,000 - 120,000; Full time

Job summary

A leading healthcare firm is seeking an experienced professional to drive innovative concepts in healthcare billing and coding. You will lead the identification and resolution of coding and billing issues, requiring a Registered Nurse with at least 5 years of experience. The role offers salary up to $120,000 per year, and the opportunity to work remotely with a competitive benefits package.

Benefits

Eligibility for discretionary bonus consideration

Competitive benefits package including medical, dental, vision, disability, and life insurance

401(k) savings plans and paid family leave

Generous Paid Time Off (PTO) ranging from 17-27 days per year

Opportunity to work remotely with flexible hours

Qualifications

• Registered Nurse required; Bachelor’s or Graduate degree preferred.
• Minimum of 5 years of experience in medical billing, inpatient and outpatient coding, auditing, or CDI.
• Proficiency in Microsoft Excel, including navigating pivot tables and conducting basic data analyses.
• Mastery of healthcare coding systems and payment methodologies (CPT, HCPCS, ICD-10, etc.).
• Strong analytical, investigative, and communication skills.

Responsibilities

• Lead the identification and implementation of innovative concepts in healthcare billing and coding.
• Investigate and define coding and billing issues using healthcare and auditing experience.
• Collaborate with cross-functional teams to align on audit opportunities and drive results.
• Educate Audit Operations leaders and Medical Directors on identified audit opportunities.
• Monitor and update concept criteria to reflect changes in legislation and policies.

Job description

Overview

Employer Industry: Healthcare Billing and Coding

Compensation and Benefits

• Salary up to $120,000 per year
• Eligibility for discretionary bonus consideration
• Competitive benefits package including medical, dental, vision, disability, and life insurance
• 401(k) savings plans and paid family leave
• Generous Paid Time Off (PTO) ranging from 17-27 days per year
• Opportunity to work remotely with flexible hours

Responsibilities

• Lead the identification and implementation of innovative concepts in healthcare billing and coding
• Investigate and define coding and billing issues using healthcare and auditing experience
• Collaborate with cross-functional teams to align on audit opportunities and drive results
• Educate Audit Operations leaders and Medical Directors on identified audit opportunities
• Monitor and update concept criteria to reflect changes in legislation and policies

Qualifications

• Registered Nurse required; Bachelor’s or Graduate degree preferred
• Minimum of 5 years of experience in medical billing, inpatient and outpatient coding, auditing, or CDI
• Proficiency in Microsoft Excel, including navigating pivot tables and conducting basic data analyses
• Mastery of healthcare coding systems and payment methodologies (CPT, HCPCS, ICD-10, etc.)
• Strong analytical, investigative, and communication skills

Preferred Qualifications

• AAPC or AHIMA coding certification preferred
• Prior auditing or consulting experience in a provider or payer environment
• Experience with ChatGPT, Copilot, or similar AI tools preferred

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