Concept Development Analyst

Overview

As a Concept Development Analyst, you will lead the identification, creation, and implementation of innovative solutions in the healthcare billing and coding field. Collaborating with a technical engineer, you will contribute to the development of data-driven queries aligned with billing policies and regulatory guidelines, such as those outlined in the CMS Medicare Claims Processing Manual. 

This role involves analyzing healthcare billing rules, translating them into actionable queries, and supporting audit and recovery initiatives. You will take ownership of each query, seeing it through the entire workstream—from initial concept development and data analysis to implementation, monitoring, and refinement based on updated bill rules and regulations. 

Leveraging your expertise in Medicare regulations, provider billing practices, and data analysis, you will assist in creating novel strategies to enhance claim selection processes, particularly in data mining and automated reviews. Your knowledge of the Medicare Claims Processing Manual, prospective payment systems, provider fee schedules, and coding guidelines will be critical in optimizing proprietary tools to ensure the highest level of payment integrity for our clients. 

Strong organizational skills, a deep understanding of payment policies, and proficiency in data analysis will drive the success of this role. Working closely with senior team members, you will refine and implement advanced approaches to improve claim selection methodologies. Additional responsibilities include monitoring query outputs, evaluating audit performance outcomes, and investigating discrepancies or variances. 

This role is dedicated to serving government payers and plays a vital part in supporting program integrity and compliance while ensuring the success of queries throughout their lifecycle. 

Responsibilities

• Spearheads the exploration, generation, and execution of pioneering concepts across various healthcare provider settings 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.
• Determines audit procedures, selection methods of found audit opportunities.
• Collaborates with engineering, analytics, audit teams, client management, and senior concept development team members to complete routine tasks.
• Leads the education and training to Training, Medical Directors, and audit leaders on 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 with a …