Healthcare Configuration Analyst – Technical Claims Editing Consultant

posted on July 9, 2018

Job Description

Location: Phoenix, AZ

Duration: 6 Months

Position Description:

  • This position is responsible to identify and analyze changes to CPT, CPCS, ICD-10-PCS, ICD-10-CM codes and proprietary laboratory codes and to facilitate the timely implementation of same across all business systems.
  • Collaborate with staff to enhance operational effectiveness and efficiency by identifying opportunities for automation of existing manual claims processes.
  • Research and resolution of complex clams and reimbursement issues.
  • Accurately elicit, analyze, research and write business requirements and provide recommendations of claim edits for Commercial and Medicare lines of business.
  • Collaborate with client and vendor to address upgrades and updates to Claims Editing System (CES) and any related hardware and/or software updates and upgrades.
  • Collaborate with Project Managers to implement larger scale updates to software applications and complex claims editing.
  • Participate in activities related to the testing of core systems, database impacts and interfaces to meet the business requirements.
  • Serve as a Subject Matter Expert on CES, code editing and claims editing focusing on Commercial and Medicare lines of business.
  • Identify and analyze coding changes as they relate to accurate claims processing.
  • Collaborate with vendor and client resources to ensure successful implementations of edit rules and regulatory updates as it pertains to Commercial and Medicare lines of business.
  • Identify, research and resolve inaccuracies and inconsistencies in the system as they impact claims payment and adjudication and other upstream and downstream transactions and processes.
  • Conduct audits of system updates and edit configuration in production to confirm system function and CES editing matches requirements.
  • Collaborate with key internal departments to manage and resolve complex claim issues, maximize operational effectiveness and support claim automation.
  • Other projects and duties as assigned.

Required Experience:

  • Three years of experience as a certified coder in a healthcare delivery setting, health insurance (payer) setting.
  • Experience and knowledge of Commercial and Medicare lines of business.
  • Experience with claims editing utilizing the CES application.

Preferred Experience:

  • Bachelor’s degree or equivalent.
  • Expertise in the implementation, support and troubleshooting of applications software.
  • Experience with configuration of business rules in a healthcare claims processing application.
  • Microsoft Word, Excel and PowerPoint skills.
  • Optum Claims Editing Software (CES) – professional and facility.

Education:

  • High school or equivalent.
  • Current and valid certification as a professional coder from an accredited institution.