New Concepts And Edits Development Specialist
- Full-Time
- Cleveland, OH
- CGI Group, Inc.
- Posted 3 years ago – Accepting applications
Job Description
New Concepts and Edits Development Specialist
Position Description
The New Concepts and Edits Specialist is a member of the CGI Payment Integrity Audit Team, with responsibility for identifying new concepts and edits for the purpose of creation of payment integrity audits. The New Concepts and Edits Specialist is charged with researching reimbursement regulations, payment guidelines, healthcare provider contracts, and health insurance industry guidance's to create edit concepts which when implemented may result in identification of improper payments on paid claims on behalf of Clients (health insurers).
The New Concepts and Edits Specialist has a sound knowledge base in edit research and development in pre-pay and retrospective medical claims auditing. Edits are developed through a well-defined process which requires the Edit Specialist to incorporate clinical experience, knowledge, and critical thinking skills in order to assess available information and render a recommendation. Edits will be developed for various Provider types and ranges of clinical services, including but not limited to acute care, outpatient, DME, Home Care, Skill Nursing, Long Term Acute Care and other care settings.
The New Concepts and Edits Specialist reports to the Audit Team Manager, who provides support, feedback, and guidance to the Edit Specialist.
Your future duties and responsibilities
Required qualifications to be successful in this role
The New Concepts and Edits Specialist is a Registered Nurse (RN) with active, unrestricted licensure through the Board or Agency charged with providing such licensure in the Auditor's state of residence and/or RHIA/RHIT/CCS certified through the American Health Information Management Association. BS in Nursing and/or Health Information Management required. Previous pre-pay or post-payment auditing experience required (Minimum 5 years).
Must have good working knowledge and experience of the different types of pay structures (fee schedule, POC, etc.) and how those can influence recovery opportunities
Minimum Education Required: Associates Degree (RHIT); Bachelors degree preferred and at least one of the following professional certifications: CCS-P, CPC, CPC-H/COC
DESIRED QUALIFICATIONS/NON-ESSENTIAL SKILLS REQUIRED
Previous payment integrity edits development experience (1- 3 years) preferred.
Est. Salary Range (Colorado Only): $68k-$109k*
At CGI we call our professionals members to reinforce that all who join our team are, as owners, empowered to participate in the challenges and rewards that come from building a world-class company. CGIs benefits include:
Competitive base salaries
Eligibility to participate in an attractive Share Purchase Plan (SPP) in which the company matches dollar-for-dollar contributions made by eligible employees, up to a maximum, for their job category
401(k) Plan and Profit Participation for eligible members
Generous holidays, vacation, and sick leave plans
Comprehensive insurance plans that include, among other benefits, medical, dental, vision, life, disability, out-of-county emergency coverage in all countries of employment;
Back-up child care, Pet insurance, a Member Assistance Program, a 529 college savings program, a personal financial management tool, lifestyle management programs and more
Build your career with us.
It is an extraordinary time to be in business. As digital transformation continues to accelerate, CGI is at the center of this change-supporting our clients' digital journeys and offering our professionals exciting career opportunities.
At CGI, our success comes from the talent and commitment of our professionals. As one team, we share the challenges and rewards that come from growing our company, which reinforces our culture of ownership. All of our professionals benefit from the value we collectively create.
Be part of building one of the largest independent technology and business services firms in the world.
Learn more about CGI at www.cgi.com .
No unsolicited agency referrals please.
Apply to this Job
Position Description
The New Concepts and Edits Specialist is a member of the CGI Payment Integrity Audit Team, with responsibility for identifying new concepts and edits for the purpose of creation of payment integrity audits. The New Concepts and Edits Specialist is charged with researching reimbursement regulations, payment guidelines, healthcare provider contracts, and health insurance industry guidance's to create edit concepts which when implemented may result in identification of improper payments on paid claims on behalf of Clients (health insurers).
The New Concepts and Edits Specialist has a sound knowledge base in edit research and development in pre-pay and retrospective medical claims auditing. Edits are developed through a well-defined process which requires the Edit Specialist to incorporate clinical experience, knowledge, and critical thinking skills in order to assess available information and render a recommendation. Edits will be developed for various Provider types and ranges of clinical services, including but not limited to acute care, outpatient, DME, Home Care, Skill Nursing, Long Term Acute Care and other care settings.
The New Concepts and Edits Specialist reports to the Audit Team Manager, who provides support, feedback, and guidance to the Edit Specialist.
Your future duties and responsibilities
- Work closely with Artificial Intelligence teams (either vendor or CGI internal) to further streamline the edit development processes.
Required qualifications to be successful in this role
The New Concepts and Edits Specialist is a Registered Nurse (RN) with active, unrestricted licensure through the Board or Agency charged with providing such licensure in the Auditor's state of residence and/or RHIA/RHIT/CCS certified through the American Health Information Management Association. BS in Nursing and/or Health Information Management required. Previous pre-pay or post-payment auditing experience required (Minimum 5 years).
Must have good working knowledge and experience of the different types of pay structures (fee schedule, POC, etc.) and how those can influence recovery opportunities
Minimum Education Required: Associates Degree (RHIT); Bachelors degree preferred and at least one of the following professional certifications: CCS-P, CPC, CPC-H/COC
DESIRED QUALIFICATIONS/NON-ESSENTIAL SKILLS REQUIRED
Previous payment integrity edits development experience (1- 3 years) preferred.
Est. Salary Range (Colorado Only): $68k-$109k*
- Disclaimer: In accordance with Colorado's Equal Pay for Equal Work Act, effective January 1, 2021, a good faith hourly or base salary range must be posted for all positions where the work may be performed in the state of Colorado. Therefore, this good faith salary range will only apply where this described position will be performed in the state, and should not be considered the compensation range in other locations or for other positions.
At CGI we call our professionals members to reinforce that all who join our team are, as owners, empowered to participate in the challenges and rewards that come from building a world-class company. CGIs benefits include:
Competitive base salaries
Eligibility to participate in an attractive Share Purchase Plan (SPP) in which the company matches dollar-for-dollar contributions made by eligible employees, up to a maximum, for their job category
401(k) Plan and Profit Participation for eligible members
Generous holidays, vacation, and sick leave plans
Comprehensive insurance plans that include, among other benefits, medical, dental, vision, life, disability, out-of-county emergency coverage in all countries of employment;
Back-up child care, Pet insurance, a Member Assistance Program, a 529 college savings program, a personal financial management tool, lifestyle management programs and more
Build your career with us.
It is an extraordinary time to be in business. As digital transformation continues to accelerate, CGI is at the center of this change-supporting our clients' digital journeys and offering our professionals exciting career opportunities.
At CGI, our success comes from the talent and commitment of our professionals. As one team, we share the challenges and rewards that come from growing our company, which reinforces our culture of ownership. All of our professionals benefit from the value we collectively create.
Be part of building one of the largest independent technology and business services firms in the world.
Learn more about CGI at www.cgi.com .
No unsolicited agency referrals please.