Edit Configuration Analyst

What You'll Do

In this role, you will have the opportunity to:

• Analyze medical claims, billing documentation, and reimbursement data to identify coding, billing, and payment accuracy opportunities.
• Research coding guidelines, payer policies, regulatory requirements, and industry standards to support claim editing initiatives.
• Develop clear, concise reports and recommendations that translate complex findings into actionable business insights.
• Evaluate claims data, reimbursement trends, and editing concepts to support policy development and operational improvements.
• Support internal claim review processes by providing coding expertise and data-driven recommendations.
• Communicate research findings, analytics outcomes, and business impacts to physician, operational, and senior leadership teams.
• Monitor regulatory, coding, and reimbursement changes to ensure ongoing compliance and alignment with industry best practices.
• Collaborate across departments to advance strategic initiatives, improve claim accuracy, and achieve organizational goals.

What You Will Bring

Required Qualifications

• Minimum of 2 years of experience with inpatient and/or outpatient medical procedure coding and billing, including medical insurance billing, auditing, line-item review, appeals, and reimbursement utilizing UB-04 and/or CMS-1500 claim forms.
• Minimum of 2 years of experience utilizing coding guidelines and industry resources, including NCCI, CPT, ICD-10, HCPCS, RBRVS, Medicare, Medicaid, commercial payer policies, and specialty society guidance.
• Minimum of 2 years of experience reviewing medical records and abstracting medical codes.
• Basic SQL knowledge and experience supporting reporting, analytics, testing, or data validation activities.
• Intermediate to advanced proficiency in Microsoft Excel and Microsoft Word.
• Strong analytical, research, organizational, written, and verbal communication skills.
• Required licensure, certification, and/or professional credentials applicable to area of expertise.
• Ability to independently manage multiple priorities and projects in a fast-paced environment.
• Ability to maintain confidentiality and comply with HIPAA requirements.

Preferred Qualifications

• Experience with data mining, data modeling, healthcare analytics, or medical claims analytics.
• Experience supporting quality assurance (QA), user acceptance testing (UAT), or claim edit testing initiatives.
• Knowledge of healthcare reimbursement methodologies, claim editing systems, and billing compliance practices.
• Experience presenting analytical findings and recommendations to clinical, operational, or leadership stakeholders.
• Familiarity with healthcare regulatory requirements and payer reimbursement policies.
• Additional certifications related to medical coding, auditing, healthcare analytics, or healthcare compliance.

Compensation

Actual compensation is based on experience, skills, education, work location, and internal equity. This position may also be eligible for incentive compensation and the comprehensive benefits outlined in the My Total Value section.

In addition, this position is eligible for health insurance, a 401(k) plan, and bonus opportunities.

Additional Information

This position requires balancing multiple projects and priorities while working independently with minimal supervision. Success in this role requires the ability to apply healthcare coding expertise, analytical thinking, and industry knowledge to solve complex business challenges and support organizational objectives.

Due to exposure to Protected Health Information (PHI), this role is designated as a High Risk Role and requires strict adherence to HIPAA, privacy, security, and confidentiality standards.

The responsibilities described above are not intended to be an exhaustive list of all duties, responsibilities, or qualifications associated with this position. Additional duties may be assigned as business needs require.

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Why Claritev?

Healthcare is complex. We help make it clearer.

At Claritev, you'll do work that matters. Together, we're helping make healthcare more transparent and affordable for all through the power of data, technology, and expertise. We offer meaningful opportunities to grow your career, collaborate with talented colleagues, and make an impact on the clients and communities we serve. If you're looking for purpose, growth, and a team that succeeds together, you'll find it here.

What Guides Us

At Claritev, innovation, agility, and a focus on results drive our success. We embrace bold thinking, work as one team, take ownership, and strive for excellence in everything we do - creating meaningful impact for our clients, communities, and each other.