Concept Development Analyst - DRG- PCCV
Remote, United States
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 …
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Must be able to perform duties with or without reasonable accommodation Must be able to provide a dedicated, secure work area
Benefits/Perks17-27 days of Paid Time Off (PTO) per year 401(k) savings plans 9 paid holidays per year Competitive benefits package Dental Disability Life Insurance Life insurance coverage Medical Medical, dental, vision, disability, and life insurance coverage Paid Family Leave Paid holidays Paid Time Off Remote work Vision
Tasks- Client management
- Collaborate with teams
- Data Analysis
- Other duties as assigned
- Research
- Special projects
- Strategic Planning
- Training
AI Analytical Analytics Audit Auditing Coding Coding practices Communication Data analysis Documentation Excel Exchange ICD-10 Medicare Microsoft Excel Operations Payment Research Strategic planning Technology
Education Certifications TimezonesAmerica/Anchorage America/Chicago America/Denver America/Los_Angeles America/New_York Pacific/Honolulu UTC-10 UTC-5 UTC-6 UTC-7 UTC-8 UTC-9