Edit Configuration Analyst

MultiPlan; McLean (VA); On-site; USD 61,000 - 82,000; Full time

Benefits offered by this job

Health insurance

401k

Bonus opportunity

Job summary

Claritev in McLean, VA seeks an Edit Configuration Analyst I to research editing concepts, apply coding standards, and analyze related claims data for accurate billing practices. You will present findings to Physician & Senior Leadership teams and work with multiple internal teams.

The role emphasizes HIPAA compliance, data handling, and collaboration across disciplines, with in-office requirements and potential shifts as needed.

Qualifications

• 2 years' experience with inpatient/outpatient medical procedure coding and billing including UB-04 or CMS 1500.
• 2 years' experience using coding guidelines and resources such as NCCI, CPT, ICD-10, HCPCS, CMS.
• 2 years' experience reading and abstracting medical codes from records.
• 1 year experience in data mining/medical claim analytics; QA or UAT preferred.
• Basic SQL and intermediate Excel/Word skills.

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.
• Monitor and summarize regulatory changes.
• Partner with management to drive department goals.
• Note the role's high-risk nature due to PHI exposure.
• Ensure HIPAA compliance and protect PHI.
• Perform other duties as necessary.

Skills

Medical coding

Data mining

QA/UAT testing

HIPAA compliance

Billing knowledge

Tools

SQL

Excel

Word

Job description

JOB SUMMARY

The Edit Configuration Analyst I performs research on editing concepts and analyzes related claims data - applying coding standards, industry knowledge and federal regulations to ensure correct billing practices. In this role, incumbent will perform research, analytics, and/or testing and present clear, concise, legible findings to internal teams including Physician & Senior Leadership teams.

JOB ROLES AND RESPONSIBILITIES:

1. Review and analyze billing for medical appropriateness and charges.
2. Research and interpret coding and billing standards.
3. Prepare clear and concise findings.
4. Produce detailed, accurate documents.
5. Assist with internal claim recommendations.
6. Communicate research and analytics results.
7. Assist with clinical education of staff.
8. Monitor and summarize trends and regulatory changes.
9. Partner with management to drive department goals.
10. Work evening or weekend hours as needed.
11. Collaborate across disciplines and departments.
12. Demonstrate commitment to core values.
13. Note the role's high-risk nature due to PHI exposure.
14. Perform other duties as necessary.
15. communicate across disciplines and departments.
16. Ensure compliance with HIPAA regulations and requirements.
17. Demonstrate Company's Core Competencies and values held within.
18. Please note due to the exposure of PHI sensitive data - this role is considered to be a High Risk Role.
19. 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:

This position works independently with minimal supervision in order to complete the outlined responsibilities. The incumbent balances several projects at a time and work is varied and complex. More complex issues are referred to higher levels. The incumbent follows established procedures and uses knowledge of the Company's general business principles, industry dynamics, market trends, and specific operational details when performing all aspects of the job.

JOB REQUIREMENTS (Education, Experience, and Training)

• 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 preferred; 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

COMPENSATION

The salary range for this position is $61k-$82k. 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.

• health insurance
• 401k
• bonus opportunity

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Why Claritev?

Healthcare is complex. We help make it clearer.

At Claritev, you'll do work that matters. Together, we're helping make healthcare more transparent and affordable for all through the power of data, technology, and expertise. We offer meaningful opportunities to grow your career, collaborate with talented colleagues, and make an impact on the clients and communities we serve. If you're looking for purpose, growth, and a team that succeeds together, you'll find it here.

What Guides Us

At Claritev, innovation, agility, and a focus on results drive our success. We embrace bold thinking, work as one team, take ownership, and strive for excellence in everything we do - creating meaningful impact for our clients, communities, and each other.