Medical Claims Analytic Researcher - work from home
This position is a work from home position, but travel will be required for the end stages of the interview process. Travel will also be required for the initial job training and any subsequent training and/or special projects.
The Medical Claims Analytic Researcher is responsible for helping to identify coding and other health care claim deviations that indicate a physician, hospital or other provider may not have properly billed for a health care service. The Analytic Researcher reports to the Director of Analytic Research.
Responsibilities include, but are not limited to: • Will be accountable for identifying, researching and documenting a specific number of medical claims coding and reimbursement issues each month • Will review detailed medical claims data to identify coding or other reimbursement issues in the claims • Will work collaboratively with a data analyst to instruct them on requirements to pull specific claim data sets for review • Will review medical coding literature and other publications to stay current on medical audit issues and trends • Will need to articulate and document the claims logic necessary to identify a known issue across a set of claims • Will need to become familiar with the coding and reimbursement rules already available in the MARS system • May be involved in training others on coding and reimbursement topics
The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified. All personnel may be required to perform duties outside of their normal responsibilities from time to time, as needed.
• License/Certification: Must be currently certified by the American Health Information Management Association in coding (CCA, CCS, RHIA, RHIT) or the American Academy of Professional Coders (CPC, CPC-P, CPC-H);
Education: Prefer a college degree or some college course work; High School Diploma or GED required
Experience: o At least 2 years of experience with health care coding o At least 4 years of experience working with medical claims data o Ability to manipulate claims data in Excel o Experience with both professional and facility coding a plus o Expert in industry standard codes including ICD diagnosis and procedure codes, revenue codes, bill types, CPT codes o Comfortable working with large amounts of claims data (SQL data mining experience a plus) o Be familiar with claim reimbursement methods, especially Medicare reimbursement
Competencies • Self-motivated and highly-productive in an independent work environment • Pay close attention to detail • Have strong logical thinking skills to enable you to clearly explain coding rules to a system developer • Comfortable with Excel • Have ability to manage multiple projects at the same time • Flexible to operate as a team player and also work independently • Smart, energetic, hard-working individual comfortable in an intense, fast-paced, demanding environment
As an Equal Opportunity Employer, the Company will provide equal consideration to all employees and job candidates without regard to sex, age, race, marital status, sexual orientation, religion, national origin, citizenship status, physical or mental disability, political affiliation, service in the Armed Forces of the United States, or any other characteristic protected by federal, state, or local law.