Edit Configuration Analyst

Claritev; United States; On-site; USD 61,000 - 82,000; Full time

Benefits offered by this job

401k with company match

Medical, dental, and vision coverage

Employee stock purchase plan

Paid time off and holidays

Job summary

Claritev is seeking an Edit Configuration Analyst I to research editing concepts and analyze claims data, applying coding standards, industry knowledge, and federal regulations to ensure correct billing practices. The role includes research, analytics, testing, and presenting clear findings to Physician and Senior Leadership teams.

The position requires 2+ years in coding, billing analytics, data mining/modeling, SQL and Excel/Word proficiency, with evening/weekend hours as needed.

Qualifications

• 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 and 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/ Proficient Excel & Word.

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.
• Ensure compliance with HIPAA regulations and requirements.

Skills

SQL

Excel

Word

Data mining

Data modeling

Medical coding

Billing analytics

QA testing

Communication

Regulatory compliance

Tools

UB-04 familiarity

CMS 1500 familiarity

Job description

Job Description

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.

• Review and analyze billing for medical appropriateness and charges.
• Research and interpret coding and billing standards.
• Prepare clear and concise findings.
• 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.

Job Summary

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

• 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.

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.

Requirements

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.

About Us

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.

About The Team

My Total Value Claritev’s Global t Otal r Ewards Philosophy — My Total Value — Is Grounded In Investing In Our Associates And Rewarding Per Formance. This Includes

• Competitive compensation and incentive opportunities (where eligible)
• Medical, d ental, and v ision coverage
• Life and d isability coverage
• 401(k) with c ompany m atch
• Employee s tock p urchase p lan
• Flexible s pending a ccounts and h ealth s avings a ccounts
• Paid t ime o ff and c ompany h olidays
• Paid p arental l eave
• Mental h ealth r e sources
• Tuitio n r eimbursement
• Financial p lanning r esources
• Professional development opportunities

Our Commitment to Inclusion

At Claritev , we believe diverse perspectives strengthen our teams and lead to better outcomes. We are committed to fostering an inclusive workplace where every associate feels respected, valued, and empowered to succeed.

Claritev is an Equal Opportunity Employer and complies with all applicable laws and regulations. Qualified applicants will receive consideration for employment without regard to age, race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other characteristic protected by law.