Edit Configuration Analyst - Research Analytics

Claritev•Irving, TX

4d•$70 - $75

About The Position

At Claritev, we pride ourselves on being a dynamic team of innovative professionals. Our purpose is simple - we strive to bend the cost curve in healthcare for all. Our dedication to service excellence extends to all our stakeholders, internal and external, driving us to consistently exceed expectations. We are intentionally bold, we foster innovation, we nurture accountability, we champion diversity, and empower each other to illuminate our collective potential. Be part of our amazing transformational journey as we optimize the opportunity toward becoming a leading technology, data, and innovation voice in healthcare. Onward and Upward! The Edit Configuration Analyst I researches editing concepts and analyzes claims data to support accurate billing practices across healthcare systems. This role applies coding standards, regulatory guidance, and industry knowledge to perform analytics, testing, and research while delivering clear findings to internal teams, physician partners, and senior leadership.

Requirements

2+ years of experience with inpatient and/or outpatient medical procedure coding and billing including insurance billing, auditing, line-item review, appeals, and reimbursement using UB-04 and/or CMS-1500 forms
2+ years of experience using coding guidelines and resources including NCCI, CPT, ICD-10, HCPCS, RBRVS, Medicare, Medicaid, and other payer guidelines
2+ years of experience reviewing medical records and abstracting medical codes
1+ year of experience in data mining, data modeling, medical claims analytics, or claim edit testing (QA or UAT) preferred
Basic SQL knowledge preferred (RA & UAT environments)
Intermediate proficiency with Microsoft Excel and Word
Relevant professional certifications or licensure as applicable
This position requires the ability to work in a standard office environment including sitting and viewing monitors for extended periods while operating standard office equipment such as a computer, keyboard, copier, and telephone.

Nice To Haves

1+ year of experience in data mining, data modeling, medical claims analytics, or claim edit testing (QA or UAT) preferred
Basic SQL knowledge preferred (RA & UAT environments)

Responsibilities

Review and analyze medical billing for accuracy, medical appropriateness, and correct charges
Research and interpret coding standards and billing guidelines to ensure compliance
Conduct claims edit research, analytics, and testing activities
Prepare clear documentation and communicate findings to internal stakeholders
Support claim review processes and internal recommendations
Assist with clinical education initiatives and training materials
Monitor and summarize industry trends, regulatory updates, and coding changes
Collaborate with leadership and cross-functional teams to support departmental goals
Ensure compliance with HIPAA and data security standards due to PHI exposure
Perform additional duties and responsibilities as assigned

Benefits

Medical (PPO & HDHP), dental and vision coverage
Pre-tax Savings Account (FSA & HSA)
Life & Disability Insurance
Paid Parental Leave
401(k) company match
Employee Stock Purchase Plan
Generous Paid Time Off — accrued based on years of service
WA Candidates: the accrual rate is 4.61 hours every other week for the first two years of tenure before increasing with additional years of service
10 paid company holidays
Tuition reimbursement
Employee Assistance Program
Sick time benefits — for eligible employees, one hour of sick time for every 30 hours worked, up to a maximum accrual of 40 hours per calendar year, unless state law provides more generous benefits