Remote Payment Integrity Analyst Jobs in Madison, WI

Come Find your Spark at Quartz! Do you have a strong background in medical coding? Are you a problem-solver that enjoys working with claim edit systems? If so, come join Quartz as a Medical Coding Systems Analyst.

The Medical Coding Systems Analyst will be responsible for oversight and maintenance of the code edit systems used by Quartz. This position will research system flags and concepts, vetting resources and guidelines, evaluating edits, testing outcomes, and presenting recommendations regarding system edits to leadership. Within these recommendations, this role will outline financial impacts, compliance with regulatory guidelines, provider contracts, and alignment with the industry. The Medical Coding System Analyst will provide integral input for system updates and enhancements in collaboration with Business Analysts and the vendors. 

Benefits:

• 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
• Starting salary is based upon skills and experience: $72,500 - $90,600 plus robust benefits package

• 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.

• 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

Hardware and equipment will be provided by the company, but candidates must have access to high-speed, non-satellite Internet to successfully work from home.

We offer an excellent benefit and compensation package, opportunity for career advancement and a professional culture built on the foundations of Respect, Responsibility, Resourcefulness and Relationships. To support a safe work environment, all employment offers are contingent upon successful completion of a pre-employment criminal background check.

Quartz values and embraces diversity and is proud to be an Equal Employment Opportunity employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sex, gender identity or expression, sexual orientation, age, status as a protected veteran, among other things, or status as a qualified person with disability.