Business Rules Analyst II

Change Healthcare    Saint Louis Park, MN
Job Description

Transforming the future of healthcare isn’t something we take lightly. It takes teams of the best and the brightest, working together to make an impact.

As one of the largest healthcare technology companies in the U.S., we are a catalyst to accelerate the journey toward improved lives and healthier communities.

Here at Change Healthcare, we’re using our influence to drive positive changes across the industry, and we want motivated and passionate people like you to help us continue to bring new and innovative ideas to life.

If you’re ready to embrace your passion and do what you love with a company that’s committed to supporting your future, then you belong at Change Healthcare.

Pursue purpose. Champion innovation. Earn trust. Be agile. Include all.

Empower Your Future. Make a Difference.Researches, interprets and writes healthcare correct coding edits using regulatory requirements and guidance related to CMS, CPT/AMA and major payer policies. Possesses an overall understanding of all coding principles, including facility, provider and DME.

What will I be responsible for in this job? (brief summary of the role)
  • Write business rules which are programmed into system edits to detect fraudulent, aberrant and abusive coding and/or billing patterns
  • Update business rules/code lists for existing system edits based on industry changes or mandates from CMS, CPT/AMA and major payer coding and reimbursement updates and provide logic enhancements to IT.
  • Monitor CMS and major payer coding and reimbursement policies
  • Utilizes systems and data to resolve business rule issues in the most effective and productive manner
  • Proof of concept development and data analysis of reports for potential edit development
  • Manage the lifecycle of the coding and insight review claim edits from concept to production
  • Analyze medical documents to evaluate potential issues of fraud and abuse
  • Coordinate activities with varying levels of leadership, insight review team, code edit team, legal counsel, internal and external customers, law enforcement and regulatory agencies, and medical professionals through effective verbal and written communications
  • Claims auditing to monitor for compliant coding and billing
  • Identify and make recommendations for enhancements to systems and processes
What are the requirements?
• Years of experience:• 2 years of coding experience or an equivalent combination of education and experience
• Education:• AS degree or Equivalent Experience in Health Information Management, preferred
  • Nationally recognized coding credential: RHIA, RHIT, CCS-P, or CPC
  • Physical requirements:

What critical skills are needed for you to consider someone for this position?
  • Strong knowledge of ICD-CM, HCPCS, CPT and Revenue Codes
  • Proven ability to review, analyze, and research coding issues
  • Reimbursement policy and/ or claims software analyst experience
What other skills/experience would be helpful to have?
  • Knowledge of claims editing software and rules development, a plus
  • Excellent communication skills both verbal and written
  • Knowledge of healthcare SIU, a plus
  • Strong time management, problem solving, organizational, and analytical skills required
  • Ability to work independently but also as a member of a team
  • Good interpersonal skills
  • Able to establish good customer relationships with trust and respect
  • Proficient in the use of Microsoft Office to include Excel, Word and Outlook
  • 4 + years of physician and hospital medical claims experience, preferred
How much should I expect to travel?
Employees in roles that require travel will need to be able to qualify for a company credit card or be able to use their own personal credit card for travel expenses and submit for reimbursement.

Join our team today where we are creating a better coordinated, increasingly collaborative, and more efficient healthcare system!

Equal Opportunity/Affirmative Action Commitment

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status.

Mon, 16 Sep 2019 07:48:26 GMT

Recent from Blog

The Jobrino blog is written with jobseeker and employers in mind to enable them to realize their full potential. Jobrino blog is your one-stop destination to find new research about the workplace and the latest insights into the employment market.

Are You Ready for 6 Different Types of Job Interviews?

Like people, job interview comes in all shape and sizes. The question is are you ready for these types of Job Interviews. Every employer has a preferred style of interviewing a candidate for obtaining information they need for their hiring decision. ...

Read more

10 Companies That Will Pay You to Travel the World

Have you ever imagined yourself to go global with your job! Yes you have heard it right, you don’t have to wait for your vacation days to kick in to travel the world. These 10 companies are searching for employees who are willing to travel on the job. So ...

Read more

How to write an effective resume to find a job

The Purpose of a Resume The purpose of a resume is to effectively communicate your assets such as, a summary of your skills, abilities, job related interests, years of experience, and accomplishments. Whether it’s a paper version or an electronic one, ...

Read more

Top Medical Careers in Demand | Jobs in the medical field that pay well

Regardless of the economic woes, the healthcare industry with highest paying jobs is one of those very few industries which always hires at an alarming rate and continue to thrive. Therefore, it wouldn’t be unfair to say that healthcare is one of the fastest growing careers in the US. ...

Read more