This position is a work from home position, however, you must be available to fly to the Newtown Square, PA office for training as well as infrequent in-person meetings. JOB SUMMARY: This position is responsible for helping to identify coding and other health care claim deviations that indicate a physician, hospital or other provider may not have properly billed for a health care service. The incumbent will create requirements to build on a software application. Requirements will stem from experience and knowledge in clinical and coding work. The incumbent will need to effectively communicate with other team members about coding research, claims issues and the software requirements they are working on. JOB ROLES AND RESPONSIBILITIES: 1. Identify, research and document individual medical claims coding/clinical and reimbursement topics. 2. Create effective software application requirements that encompass an individual coding/clinical research topic. 3. Utilize claims data mining tools to aid in creating software application requirements including raising questions related to software application requirements based on data mining results. 4. Apply table driven system logic to create software application requirements. Articulate and document the logic necessary to populate the system tables in a way that correctly identifies issues on a claim. 5. Deliver useful Peer QA feedback on individual coding/clinical concepts including identifying gaps in research and suggestion on changes to factor language. 6. Become familiar with existing system requirements/coding and reimbursement rules already available in the MARS system. 7. Manage and maintain compliance of work in accordance with the departmental release cycle. 8. Collaborate, coordinate, and communicate across disciplines and departments. 9. Ensure compliance with HIPAA regulations and requirements. 10. Demonstrate Company's Core Competencies and values held within. 11. Please note due to the exposure of PHI sensitive data -- this role is considered to be a High Risk Role. 12. 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 works independently with limited supervision to complete the outlined job responsibilities. This is a research position that involves varied and complex work. An individual research topic will be provided, but the incumbent must be able to interpret and translate the research into software application requirements independently. This position requires creativity and expert problem solving skills to complete the responsibilities as assigned. The incumbent uses knowledge of the Company's general business principles, industry dynamics, market trends, and specific operational details when performing all aspects of the position.
* The salary listed in the header is an estimate based on salary data for similar jobs in the same area. Salary or compensation data found in the job description is accurate.