Edit Configuration Analyst - Research Analytics

Edit Configuration Analyst I

Job Summary

The Edit Configuration Analyst I performs research on editing concepts and analyzes related claims data, applying coding standards, industry knowledge, and federal regulations to ensure accurate billing practices.

This role is responsible for conducting research, analytics, and testing activities, and presenting clear, concise findings to internal stakeholders, including Physician and Senior Leadership teams.

Key Responsibilities

• Review and analyze billing for medical appropriateness and accuracy of charges
• Research and interpret coding and billing standards
• Perform job-specific functions, including:
• Data analysis using SQL
• Testing procedures for editing logic
• Resolving incorrect results
• Researching billing and coding concepts
• Prepare clear and concise findings and documentation
• Produce detailed and accurate reports
• Assist with internal claim recommendations
• Communicate research and analytics results to cross-functional teams
• Support clinical education initiatives for internal staff
• Monitor and summarize trends, regulatory updates, and billing changes
• Partner with management to support departmental goals
• Collaborate across disciplines and departments
• Ensure compliance with HIPAA regulations and requirements
• Demonstrate alignment with company core competencies and values
• Perform other duties as assigned
• Please note due to the exposure of PHI sensitive data - this role is considered to be a High Risk Role.
• The position responsibilities outlined above are in no way to be construed as all encompassing. Other duties, responsibilities, and qualifications may be required and/or assigned as necessary.
  

Job Scope

This position operates independently with minimal supervision while managing multiple projects simultaneously. Work is varied and moderately complex, with more complex issues escalated to higher levels.

The role requires application of industry knowledge, business principles, and operational processes to support accurate claims editing and billing practices.

Compensation

The salary range for this position is $70-75k annually. Specific offers take into account a candidate’s education, experience and skills, as well as the candidate’s work location and internal equity. This position is also eligible for health insurance, 401k and bonus opportunity.

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Required Qualifications

• Bachelor’s degree in healthcare, business, or related field
• 2 years of experience in inpatient/outpatient medical coding and billing, including:
• Medical insurance billing
• Medical Procedure Coding
• Auditing and line-item review
• Appeals and reimbursement
• UB-04 and/or CMS 1500 forms with familiarity with international equivalents (e.g., KSA, ICD-10-AM, ACHI, CCI)
• 2 years of experience with coding guidelines and resources, including:
• NCCI, CPT, ICD-10, HCPCS
• Medicare, Medicaid, and other payors
• Experience reading and abstracting medical codes from medical records
• 1 year of experience in one or more of the following:
• Data mining or modeling
• Medical claims analytics
• QA/UAT testing or claim edit testing
• Required certification (must be active and maintained):
• CCS, CCS-P, CPC, RHIA, RHIT, or Nursing credential
• Strong knowledge of:
• UB-04 claims, revenue codes
• CPT, HCPCS, ICD-10
• DRG and APC methodologies
• Basic SQL experience
• Intermediate proficiency in Excel and Word
  

Preferred Qualifications

• Experience with SAFe (Scaled Agile Framework)
• Agile, Project Management, or Testing certifications (CPSO, CSM, PMP, ISTQB, etc.)
• Experience with international billing systems or coding standards
  
  

Additional Requirements

• Ability to work in a standard office environment with prolonged computer use
• This role is classified as high-risk due to PHI exposure
  
  

Benefits

We realize that our employees are instrumental to our success, and we reward them accordingly with very competitive compensation and benefits packages, an incentive bonus program, as well as recognition and awards programs. Our work environment is friendly and supportive, and we offer flexible schedules whenever possible, as well as a wide range of live and web-based professional development and educational programs to prepare you for advancement opportunities.

Your Benefits Will Include

• Medical (PPO & HDHP), dental and vision coverage
• Pre-tax Savings Account (FSA & HSA)
• Life & Disability Insurance
• Paid Parental Leave
• 401(k) company match
• Employee Stock Purchase Plan
• Generous Paid Time Off — accrued based on years of service
• WA Candidates: the accrual rate is 4.61 hours every other week for the first two years of tenure before increasing with additional years of service
• 10 paid company holidays
• Tuition reimbursement
• Employee Assistance Program
• Sick time benefits — for eligible employees, one hour of sick time for every 30 hours worked, up to a maximum accrual of 40 hours per calendar year, unless state law provides more generous benefits
  
  

EEO Statement

Claritev is an Equal Opportunity Employer and complies with all applicable laws and regulations. Qualified applicants will receive consideration for employment without regard to age, race, color, religion, gender, sexual orientation, gender identity, national origin, disability or protected veteran status.

Application Deadline

We will generally accept applications for at least 5 business days from the posting date or as long as the job remains posted.