Concept Development Analyst - DRG- PCCV Job Locations

US-Remote ID

2024-12703

Category Audit - Healthcare  

Position Type Full-Time Overview

As a Concept Development Analyst (CDA) within the Clinical Chart Validation team, you'll spearhead the identification, creation, and implementation of inpatient claim selection rules focusing on the payment integrity of the billed DRG. Leveraging your industry experience and deep knowledge of inpatient coding practices, APR-DRG methodologies, and billing regulations, you'll craft innovative strategies to enhance claim selection processes, contributing directly to payment integrity for our clients.

Your data analysis expertise, strong organizational skills, and comprehensive understanding of claim selection methods will be instrumental in innovating and optimizing proprietary tools that uphold the highest standards of payment accuracy. You'll work closely with senior team members, playing a pivotal role in refining and executing methodologies that elevate our claim selection strategies focused on inpatient claims.

This position involves research, development, implementation, and maintenance of new audit opportunities, with a primary focus on DRG validation for both pre- and post- payment opportunities. As a CDA, you'll be responsible for monitoring query outputs, tracking audit performance outcomes, and investigating discrepancies or variances, ensuring consistent alignment with our team's objectives and the evolving needs of the healthcare billing landscape.

We are seeking candidates with a proven track record of possessing strong analytical and research skills. The ideal candidate should demonstrate the ability to critically analyze information, think logically, and draw meaningful insights from data. Additionally, a keen attention to detail and the capacity to conduct thorough research to gather relevant information are paramount.

Candidate must be self-motivated and capable of working independently, demonstrating the ability to make sound decisions autonomously when necessary.

Responsibilities

Spearheads the analytical exploration, generation, and execution of unique selection rules focused within our inpatient claim audit scope. * Create selection rules that are complementary of existing library, by leveraging your in-depth insights into healthcare billing and coding practices, clinical insights, and regulatory knowledge. * Leads the effort to identify coding and billing logic development opportunities. * Utilizes healthcare and auditing experience to investigate, identify and define coding and/or billing issues. * Participates in strategic planning to develop methods for integrating new technology into existing tools * Collaborates with engineering, analytics, audit teams, client management, and senior concept development team members to complete routine tasks. * Leads the education and training to the Auditor Training Team, Medical Directors, and audit leaders on new DRG audit opportunities independently found or assigned. * Communicates results with senior team members and managers effectively. * Demonstrates the ability to expand concepts based on customer requirements and scope * Proficient with Medicare reimbursement methodologies, coding and billing guidelines and applicable industry-based standards. * Demonstrates ability to monitor and update concept criteria and logic frequently to reflect any changes in legislation, rules, and policies. * Fosters and implements new ideas, approaches, and technological improvements to support and enhance audit production, communication and client satisfaction. * Assists with ongoing review of all concepts prior to and after implementation * Creation and maintenance of... For full inf o follow application link.

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities