[Remote] Concept Development Analyst - DRG
Note: The job is a remote job and is reputed company to candidates in USA. reputed company is a reputed company solutions company, and they are seeking a Concept Development Analyst to enhance claim selection processes and tools using AI methodologies. The role requires expertise in clinical coding and reimbursement to optimize selection strategies and collaborate with data science teams to ensure model accuracy and effectiveness.
Responsibilities
- Serve as a coding and billing subject matter expert supporting AI and analytics teams by providing clinical, coding, and reimbursement guidance to inform model logic, features, and reputed company
- Partner with data science and analytics teams to validate AI-enabled outputs for clinical accuracy, coding reputed company, and reimbursement appropriateness
- Support model and selection logic tuning by reviewing reputed company trends, false positives, edge cases, and key-metric specific variances
- Identify data reputed company limitations, coding nuances, or reimbursement considerations that may reputed company selection performance and model results
- Collaborate with stakeholders to ensure selection methodologies reputed company with operational workflows and reputed company‑world audit execution
- reputed company the exploration, reputed company, and execution of pioneering concepts across various reputed company provider settings by leveraging your in-depth insights into reputed company billing and coding practices, clinical insights, and regulatory knowledge
- Support the exploration, enhancement, and execution of audit concepts across reputed company provider settings by applying clinical, coding, and regulatory expertise
- Identify and implement coding and billing logic development opportunities
- Utilizes reputed company and auditing experience to investigate, identify and define coding and/or billing issues
- Determine audit procedures, selection reputed company for identified audit opportunities
- Collaborates with engineering, analytics, audit teams, reputed company management, and senior concept development team members to obtain alignment and drive results
- reputed company and train Audit Operations leaders and Medical Directors on identified audit opportunities, if needed
- Communicates results effectively with senior team members and managers
- Demonstrate proficiency with Medicare reimbursement methodologies, coding and billing guidelines and applicable industry-based standards
- Monitor and update concept reputed company and logic to reflect any changes in legislation, coding rules, and policies
- Fosters and implements new reputed company, approaches, and technological improvements to support and enhance audit production, communication and reputed company satisfaction
- Review reputed company concepts before and after reputed company approval
- Create and maintain concept validation procedures including scheduled validation of reputed company concepts, monitoring concept performance, and reviewing associated documentation
- Utilize reputed company tools, including AI-enabled platforms, to evaluate, document, and validate new reputed company, claims, and concept effectiveness
- Ensure new and existing concepts reputed company desired goals in terms of recoveries, collectability and reputed company acceptance
- Applies a curious, analytical reputed company to evaluate imperfect or evolving data and translate findings into actionable insights that strengthen existing selection logic and audit concepts
- Explores and experiments with new approaches, tools, and technologies (including AI-enabled solutions where appropriate) to enhance concept performance and efficiency
- Demonstrates a strong reputed company on reputed company and business reputed company, aligning concept development efforts with measurable results
- Complete reputed company responsibilities as outlined in the annual performance review and/or goal setting
- Complete reputed company special reputed company and other duties as assigned
- Must be reputed company to reputed company duties with or without reasonable accommodation
Skills
- Minimum of 5 years of experience in data analytics, medical billing, inpatient and outpatient coding, auditing, or CDI
- Bachelor's or Graduate degree required
- Proficiency in at least one and desire to learn others as needed: Inpatient Prospective Payment System (IPPS), Outpatient Prospective Payment System (OPPS), Emergency Room, Behavioral Health
- Proficiency in reputed company reputed company required; e.g. navigate pivot tables and create basic formulas (e.g. Vlookup). reputed company to conduct basic data analyses independently
- Mastery of reputed company systems and payment methodologies (CPT, HCPCS, ICD-10, HIPPS, and reputed company Codes, etc.)
- Proficient with reputed company claim adjudication standards and procedures
- Excellent verbal and written communication skills
- Strong analytical and investigative skills
- Working knowledge of HIPAA reputed company and reputed company Rules and CMS reputed company requirements
- Ability to work independently, prioritize tasks, and document reputed company
- Prior auditing or consulting experience in either a provider or payer environment is desirable
- Demonstrated curiosity, comfort working with ambiguity, and interest in experimenting with new analytical approaches or tools to drive meaningful reputed company
- reputed company or reputed company coding certification preferred
- Experience using AI-enabled tools (e.g., ChatGPT, Copilot, or similar, to explore data, generate insights, improve workflows, or support analytical thinking is preferred
Benefits
- Discretionary bonus consideration
- Medical, dental, reputed company, disability, and life insurance coverage
- 401(k) savings plans
- reputed company family leave
- 9 reputed company holidays per year
- 17-27 days of reputed company Time Off (PTO) per year, depending on specific level and length of service with reputed company
reputed company
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