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Clinical Content Analyst
Location: This position will work a hybrid model (remote and office). The Ideal candidate will live within 50 miles of one of our Elevance Health PulsePoint locations.
The Clinical Content Analyst will be responsible for driving the development and execution of the Clinical Content scope in alignment with the product and content strategy to meet financial and operational targets. As a Clinical Content Analyst, you'll research and interpret CMS, CPT/AMA and other major payer policies based on healthcare correct coding and regulatory requirements. You'll identify common error areas that can be made into automated software logic that prevent overpayments from occurring. You'll take your edits from concept to specification and then through review, testing and finally data validation. Your goal is to develop claims editing logic and content that promote payment accuracy and transparency across Medicaid, Medicare, and Commercial lines of business.
How you will make an impact:
- Oversee the conception and development of new content.
- Provides data-based reports and recommendations to optimize content performance and guide content strategy.
- Review healthcare policy (Medicaid manuals, fee schedules, CCI, OIG Alerts, LCAs/LCDs, NCDs, Medicare manuals, etc.) for coding and billing guidelines that can be turned into software editing rules.
- Create billing edits that provide clients with monetary savings and promote coding accuracy.
- Use structural design to turn policy language into specifications that developers turn into software coding edits or logic.
- Build unit tests to verify the functionality of the edits.
- Apply revenue cycle, coding, and billing expertise to interpret policy based on correct coding, billing, and auditing guidelines.
- Provide in-depth research on regulations and support edits with official documents.
- Validate if edits are working as intended and support decisions with validation data.
- Analytical and able to present to business partners (internal/external) to demonstrate the content value.
- Maintain current industry knowledge of claim edit references including, but not limited to: AMA, CMS, NCCI.
- Collaborate with the Content and Engineering & Data teams to develop, adjust, and validate edits.
- Independently meet weekly productivity and quality goals.
- Curates source content.
- May develop and maintain the content plan, own and manage content maintenance plan to ensure content supports strategy.
- Contributes to a core center of excellence for digital editing content.
Requires a BA/BS in a related field and a minimum of 5 years of related experience; or any combination of education and experience, which would provide an equivalent background.
Preferred Skills, Capabilities, and Experiences:
- Masters and Scaled Agile Framework Training preferred.
- 5+ years of claims editing experience with healthcare payers and/or claims editing software vendors, strongly preferred.
- Billing, coding, revenue cycle, and claims editing software experience, strongly preferred.
- Nationally recognized coding or billing credential required: CCS, CCS-P, CPC, CPB.
- Experience in claims adjudication and application of NCCI editing and claims payment rules.
- Ability to interpret claim edit rules and references.
- Solid understanding of claims workflow including the interconnection with claim forms
- Ability to apply industry coding guidelines to claim processes.
- Proven experience reviewing, analyzing, and researching coding issues for payment integrity.
- Logic skills: ability to break policy edits down into decision making paths.
- Ability to troubleshoot and apply root-cause analysis of logics not functioning as intended.
- Intermediate level proficiency in Excel (ability to manipulate data using excel functions along with pivot tables, v-look up, etc).
- SQL query-building and lookup skills.
Locations: California, Colorado, New Jersey (Jersey City Only), New York
In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the company. The company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.
* The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law.
Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Who We Are
Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
How We Work
At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.comfor assistance.
Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Who We Are
Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
How We Work
At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.comfor assistance.
