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Clinical Systems Analyst - Work from home
at MultiPlan, Inc.
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.
The incumbent in Clinical Systems Analyst position must meet the job requirements and should be able to perform the roles and responsibilities of the Clinical Systems Researcher, in addition to those outlined in this job description.
JOB ROLES AND RESPONSIBILITIES:
1. Identify, research and document individual medical claims coding/clinical and reimbursement topics. Construct research papers around a specific topic and present research findings to peers within the department.
2. Create effective software application requirements that encompass a variety of coding/clinical research topics.
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, interpreting claims data and applying common aggregations of data to modify software application requirements and using common aggregations of data to test design of system requirements.
4. Apply table driven system logic and pre-defined advanced query 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. Act as a mentor to more junior team members.
6. Deliver effective Peer QA feedback on multiple related coding/clinical concepts and research papers including; identifying gaps in research and advising on changes to factor language and system logic, and recommending when more advance software capabilities could be incorporated.
7. Manage assigned projects & functions above daily work.
8. Gain an understanding of existing system requirements/coding and reimbursement rules already available in the MARS system, while demonstrating familiarity with existing system rules related to incumbent's specialty area.
9. Manage and maintain compliance of oneself and peers work in accordance with the departmental release cycle.
10. Collaborate, coordinate, and communicate across disciplines and departments.
11. Ensure compliance with HIPAA regulations and requirements.
12. Demonstrate Company's Core Competencies and values held within.
13. Please note due to the exposure of PHI sensitive data -- this role is considered to be a High Risk Role.
14. 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.
This position works independently with minimal supervision to complete the outlined job responsibilities. This is a research position that involves varied and complex work. A research topic may be provided but the incumbent needs to be able to appropriately determine the scope of the topic. Must be able to interpret and translate 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.
MultiPlan offers opportunity. Recognition. And satisfaction.
At MultiPlan, our employees are instrumental to our success and we reward them accordingly. We offer a very competitive compensation and benefits package, an incentive bonus program, service recognition awards and an employee recognition program that honors individuals whose achievements go above and beyond even our high expectations.
One of our top priorities is the career development of our employees. We place a strong emphasis on promotion from within and on educational programs. To foster your professional development and growth, our Corporate Education and Development offers you several skills training opportunities to fit your schedule and help you succeed at MultiPlan.
We focus on creating a collegial workplace in a business-casual dress environment. We offer flex-time as needed to interested employees where feasible. We plan occasional social activities, such as holiday events, where our employees can spend time with their colleagues and we support and encourage employee participation in charitable giving activities.
We're glad that you have taken the time to get acquainted with MultiPlan and hope that you will consider joining our team.
MultiPlan is an Equal Opportunity Employer M/F/D/V
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JOB REQUIREMENTS (Education, Experience, and Training):
* Minimum Associates degree + 7 years, OR 9 years in a clinically related field including but not limited to; coding, nursing, radiology, laboratory, pharmacy, physician assistant.
* Preferably with expertise in at least three coding/clinical specialties, or 10+ years in a single specialty.
* Needs skills in areas like; auditing of team members, auditing of external providers, responding to claim denials, claims data mining, QA of coding work, health plan policy creation, health plan claims editing, utilization management.
* Must possess an active applicable related certificate or license
* Exhibit advanced proficiency in Microsoft Excel
* Able to quickly learn new computer applications including data mining tools.
* Have previous exposure to database structure and programs such as Microsoft Access or SQL.
* Individual must be comfortable researching highly-technical information on the internet. Familiarity with medical coding sources such as CPT Assistant, medical association publications supporting medical coding and clinical research websites is expected.
* Display a strong understanding of human anatomy and medical terminology.
* Extensive knowledge of claims data and associated industry-standard codes such as CPT, ICD diagnosis, revenue, bill type and admit/discharge status codes.
* Must be extremely detail-oriented.
* Possess strong writing and verbal communication and be able to translate difficult clinical concepts into easier-to-understand language for non-clinical readers.
* Individual in this position must be able to work in a standard office environment which requires sitting and viewing monitor(s) for extended periods of time, operating standard office equipment such as, but not limited to, a keyboard, copier and telephone.
As an Equal Opportunity Employer, the Company will provide equal consideration to all employees and job candidates without regard to sex, age, race, marital status, sexual orientation, religion, national origin, citizenship status, physical or mental disability, political affiliation, service in the Armed Forces of the United States, or any other characteristic protected by federal, state, or local law.