Note: The job is a remote job and is open to candidates in USA. Quartz Health Solutions is seeking a Coding Systems Analyst to oversee and maintain the code edit systems. The role involves researching system flags, evaluating edits, testing outcomes, and presenting recommendations regarding system edits to leadership.
Responsibilities
- Research official coding guidelines, industry sources, Quartz contracts, to evaluate and test system edits to support coding compliance and payment integrity
- Presents recommendations, including positive or negative financial savings to multi-disciplinary teams and leadership using analytics and industry research
- Collaborates with business analysts to provide input and quarterly system updates and enhancements to systems, as well as be responsible for routine system maintenance
- Prepares educational material to present to providers on new edits and financial impact
- Monitors, analyzes, and reports trends to leadership and providers, daily, of system performance
- Collaborates across multi-disciplinary teams to assure coding and billing compliance
Skills
- Bachelor's degree with 2+ years of relevant coding experience
- OR associate degree with 5+ years of relevant coding experience
- OR high school equivalency with 8+ years of relevant coding experience
- Completion of medical coding program (obtained certification in CPC, COC, RHIT, RHIA, CCA, and/or CCS)
- Epic healthcare software and/or system knowledge of Optum CES or Claritev ACE claim editing systems
- Intermediate level of proficiency with MS Office (Word, Excel, PowerPoint, and Outlook)
- Ability to decipher complex CMS coding and billing regulations for all types of coding
- Strong working knowledge of medical coding, fee, and reimbursement mechanisms
- Strong understanding of medical coding and regulatory guidelines, which may include - CPT, HCPCS, ICD10, OPPS, IPPS, DRGs
- Strong knowledge of governmental medical payment policies/regulations and their update process (Medicare, Medicaid, DSNP, SSI, etc.)
- Knowledge of HIPAA regulations
- Ability to understand and discuss technical software issues with others
- Strong analytical and problem-solving skills using critical thinking skills
- Strong verbal and written communication skills
- Self-motivated, organized, with the ability to work independently to successfully investigate complex issues, and manage multiple tasks simultaneously and complete timely
- Ability to engage and work in a collaborative team environment
Benefits
- Robust benefits package
- Work with two separate claim edit systems and vendors to help Quartz achieve maximum savings
- Work cross-collaboratively to help build out new secondary code edit system
- Be part of the new payment integrity business initiatives and goals
Company Overview