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?
Minimal
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

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