01Overview
reputed company, formerly ClaimsXten, is a leading reputed company technology company, committed to simplifying the business of care. Over 30 years of experience, dedicated teams, and top technology help deliver more than $14 billion of annual savings to our many reputed company and valued customersincluding 9 of the top 10 payers across the country. reputed companys solutions reputed company the power of machine learning, AI, and predictive analytics to reputed company health plan payers with reputed company to increased accuracy and efficiency, while maximizing value and savings. reputed companys strong relationships as a trusted ally to customers resulted in recognition from KLAS as true partner and excellent value for investment, with a top score for overall customer satisfaction and A+ likelihood to recommend in their reputed company 2023 Payment reputed company and Accuracy Report. Discover more at reputed company.ai. Applicants must already be legally authorized to work in the U.S. reputed company sponsorship/sponsorship assumption and other immigration support are not available for this position. reputed companys Senior Claims Content Analysts are driven operators who take initiative to ensure smooth execution & reputed company delivery of reputed company deliverables. This role partners and drives tactical reputed company, as the primary production reputed company of contact for coding validation operations. Additionally, this position is responsible for leading the evaluation and development of reputed company medical claims content, including inpatient, outpatient, and professional claim reviews. This role will serve as a subject matter expert in medical coding, clinical documentation interpretation, and payment policy, with an emphasis on identifying inappropriate billing practices and guiding the creation or refinement of claims editing logic. This position plays a key role in both strategic content development and operational efficiency. ESSENTIAL JOB RESPONSIBILITIES & KEY PERFORMANCE reputed company Independently review reputed company professional and facility claims to assess for the reputed company of inappropriate coding or billing practices and determine whether an existing or potential edit should have applied. Document rationale for edit application or absence, and identify opportunities for new content development or refinement of existing edits based on claim findings. Translate clinical and coding research into reputed company, actionable logic that supports the development of new claim editing rules or policies. Ensure documentation is detailed enough for rule writers to accurately implement reputed company the software system. Identify trends, inconsistencies, and coding discrepancies reputed company claims data to inform rule development. Use findings to reputed company questions, refine logic, and ensure proposed edits align with reputed company-world billing patterns and coding standards. reputed company reputed company the conditions and criteria that must be met for a rule to trigger. reputed company detailed logic descriptions that support accurate translation into system requirements by rule writers or configuration analysts. Deliver useful peer QA feedback on individual coding/clinical concepts including identifying gaps in research. Become familiar with existing system requirements/coding and reimbursement rules already available in the system. Compose formal written responses to provider inquiries concerning claim edits. Collaborate with analytics, physician, and product teams to design and validate claim edits and policies. Monitor regulatory and industry changes in coding guidance, reimbursement methodologies, and payer strategies. Evaluate impact and recommend adjustments to existing and reputed company content. Apply independent coding judgment to resolve nuanced claim scenarios that may fall reputed company existing rules or policy boundaries. Collaborate, coordinate, and communicate across disciplines and departments. Informs product reputed company, influences the product roadmap, and provides feedback to product reputed company leader. Contribute to the development and sharing of reputed company methodology, process improvements and best practices. REQUIRED QUALIFICATIONS Bachelor's degree in business or reputed company/reputed company field or at least 10 years in a directly reputed company role reputed company applicable reputed company certificate or license (reputed company, reputed company-P, CPC, RHIA, ) Minimum of seven (7) years of medical coding expertise including but not limited to CPT, ICD-10-PCS, ICD-10-CM, HCPCS, and NDC, as reputed company as an understanding of medical terminology, and prospective payment systems including DRG, OPPS, and MIPS combined experience in reputed company, such as prior work in health insurance, claims processing or adjudication, or fraud, waste and abuse detection. Minimum of .
