Data Driven Edit
2 months ago
KEY RESPONSIBILITIES:
Primary focus onData Driven Edit (DDE)development
Research, build and test edits to be used in the Claims Editing library of edits.
Use of strong coding and industry knowledge to build edits and editing content (data used by the edits).
Ensure compliance with HIPAA regulations and requirements.
Ensure adherence to quality assurance guidelines.
Serve as a subject matter expert for edits and provide support where needed.
Work closely with client teams to provide coding expertise for customer and provider inquiries
Provide written response, documentation and rationale for inquiries as needed.
Utilize the most up-to-date approved Zelis medical coding sources for edit development while also advisingappropriate personnel of important changes, issues, and trends.
Test and validate changes made to the edit(s).
Monitor, research, and summarize trends, coding practices, and regulatory changes.
Performs other related responsibilities and special projects as assigned.
Maintains awareness of and ensure adherence to ZELIS standards regarding privacy.
Partner with other areas to assess and communicate impact to the business for additions, changes, or updates as it relates to edit updates.
PROFESSIONAL EXPERIENCE:
5+ years’ experience healthcare or related industry.
Current certified coder(CCS, CCS-P or CPC), or registered health information technician (RHIA/RHIT), or RN, LPN with coding knowledge.
Proficient in Microsoft Word and PowerPoint.
Intermediate to Advanced Excel skills preferred.
Creative problem-solving skills, leveraging insights and input from other parts of an organization while remainingcurious
Consistently demonstrate ability to act and react swiftly to continuous challenges and changes.
Excellent analytical skills with data and analytics related solutions.
Excellent communication skills.
Strong organization and project / process management skills.
Strong initiative, self-directed and self-motivation.
Good negotiation, problem solving, planning and decision-making skills.
Ability to manage projects simultaneously and achieve goals.
Excellent follow through, attention to detail, and time management skills.
EDUCATION:
Current, active CPC or equivalent credentialing required.
Bachelor’s Degree Preferred in business, healthcare, or technology preferred.
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