|Required Experience:||5 to 7 years
|Location:||1701 Duke Street Alexandria 22314, VI, US* Note: This listing is for a remote position
You’ll have a positive impact on the world.
Each year in America, healthcare businesses waste millions of hours and billions of dollars trying to get payments right. Our flexible software and accurate data feeds help clients eliminate this administrative waste, work more closely with their partners, and ultimately, provide more certainty for people at the point of care.
By joining us in fixing this gnarly problem, you’ll be helping to improve the healthcare system overall, with knock-on effects for everyone in America.
Your Contributions Truly Matter
We’re a growing company, so you’ll be given plenty of creative freedom and the opportunity to thrive—everything you do will count.
This role involves providing support to the Policy and Data Team, Developers, QA, and others through strong analytical and research skills. The ideal candidate will analyze clinical guidelines and policies. In addition, the position will create the business requirements related to assigned provider payment policies, create test claims for User Acceptance Testing (UAT) and Quality Assurance (QA), and perform other tasks necessary to ensure Burgess' product offerings are accurate and current and relevant.
What the Role Involves (Responsibilities)
- Continually assesses and evaluates clinical edit compliance with CMS, Medicaid, and industry standards
- Reads and analyzes medical policy including final rulings, daily transmittals, bulletins, policy manual updates and more to begin the cycle of product development/maintenance
- Analyzes, reviews, studies and verifies data as it becomes available from government and other policy agencies. This can be a 1,200 page provider manual or revisiting a physician fee schedule (data file) that has been reposted
- Contacts various entities to clarify new and existing policy
- Develops formal clinical edit criteria within system payment rules and develops clinical policy billing rules
- Acts as a clinical liaison and subject matter expert with internal staff and clients
- Engages existing clients to identify specific functionality requirements
- Suggests and presents claim edits to clients for selection
- Coordinates with developers, QA, and client service team members to ensure that clinical edits are implemented accurately and timely
- Writes requirements
- Develops test claims for UAT and QA
- Develops and maintains a high level of proficiency in the Company’s products (software, data) and services (advisory, analytic, training/education), including commercial contracting features as related to the specific area(s) assigned
- Develops and delivers internal and external educational presentations related to Medicare/Medicaid reimbursement or commercial contracting features
What You've Got (Qualifications & Skills)
- Bachelor’s Degree or above
- 5+ years professional experience in a fast-paced health care environment
- Extensive background of ICD-9 and CPT coding principles
- Extensive knowledge of medical claim editing (NCCI, etc.)
- Knowledge of industry standard payment rules and methods
- Recognized prior expertise in claims processing, payment policy, or contracting
- Facility in using MS Office (Word, Excel, PowerPoint, Access) software applications
- Facility in using various Web-based and other research sources and tools
- AHIMA, AAPC or other nationally recognized coding certification [Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) certification], preferred
- Excellent Communication Skills
- Self-motivated with the ability to work independently and in a team environment
- Critical (analytic) thinking, looking into logic-based details while problem-solving for the overall big picture
- Professional poise: ability to credibly interact with and educate various internal and external groups and individuals (colleagues, clients, industry groups), effectively navigating organizational environments and managing expectations
- Ability to foster professional and personal respect and collaboration
- Team building and people development and management skills
Who You Are (Ideal Competencies/Skills)
- Creative entrepreneur. You have a constant drive to make things better; you question the status quo and approach common challenges with creativity and constructive criticism. You have skills to clearly and convincingly share ideas in a way that adapts to your audience, regardless of function, level, or expertise.
- Critical, big-picture thinker. You have a constant thirst for knowledge and the ability to credibly share it with others, whether internally or externally. You are analytical, evaluating logic-based details while always considering and problem-solving for the sake of the big picture.
- Self-starter. You are proactive, self-motivated, and able to push work, start initiatives, and provide ideas independently in a team environment.
- Team player & coach. You can foster professional and personal respect from others and find success in a team setting. While highly collaborative, you have natural management skills and know how to grow and develop people.
- Adaptable multi-tasker. You are highly organized and flexible. You know how to manage expectations and are able to thrive in fast-paced, constantly changing environments and successfully adapt to a variety of tasks.
How We Work (Team & Culture)
- Collaborative. We work together and help each other do our best by building on our work across teams and offices. We don’t own individual ideas or seek credit.
- User-driven. We place our clients and our users’ needs above all else. If it matters to a user, it matters to us. We work for them and keep ourselves accountable to that.
- Hands-on. We don’t wait for problems to solve themselves. We enter the thick of it and get things done.
- Impact over ego. Our culture is about results, not ownership. Great ideas have seniority over titles and levels, and great thinkers outshine fancy pedigrees.
- Forward-looking. We look beyond our own world to constantly improve our business. We welcome outside speakers, tap into the latest tech, and make sure we’re future-proof in anticipation of what’s coming next.
- Caring & close knit. We know and care about our people. We know each other’s project strengths—but also about upcoming family trips and favorite after-work drinks