Sr. Business Analyst Clinical & Payment Integrity

Corvel Baltimore , MD 21203

Posted 3 weeks ago

CorVel is a national provider of industry-leading workers' compensation solutions for employers, third-party administrators, insurance companies, and government agencies. Our continual investments in technology and human capital enable us to deliver the most innovative, integrated solutions. We are a stable and growing company with a strong, supportive culture along with plenty of career advancement opportunities.

Sr. Business Analyst, Clinical & Payment Integrity will analyze the changing landscape in healthcare and understands key trends. Experience with analytics to develop high impact solutions. The successful candidate will demonstrate a unique blend of product and market domain expertise, business acumen, creativity, business judgment, entrepreneurial spirit, industry knowledge, and analytical knowledge.

Responsibilities:

  • Review Medicare/State rules and regulations pertaining to appropriate billing

  • Applies critical review judgment to make clinical determinations of medical information reviewed

  • Identify facility billing and coding inaccuracies

  • Collect supporting data and analyze information to make decisions regarding the appropriateness of billing, delivery of care and treatment plans

  • Assists with project data analysis, reporting, and feedback

Qualification:

  • Thorough knowledge of medical billing codes including but not limited to CPT, ICD-10-PCS, ICD-10-CM, HCPCS, NDC, and PDPM as well as an understanding of medical terminology

  • Demonstrated knowledge of coding instructions, conventions, and guidelines as well as a thorough knowledge of prospective payment systems including DRG, OPPS, and MIPS

  • Demonstrated experience in medical review, chart audits, and quality improvement processes

  • Demonstrated ability to apply critical review judgment to make clinical determinations

  • Working knowledge of HIPAA Privacy and Security Rules

  • Ability to be careful and thorough about detail

  • Ability to analyze information and use logic to address work-related issues and problems

  • Ability to multi-task

  • Demonstrated proficiency in basic computer skills and typing, i.e., Microsoft Windows, Outlook, Word, PowerPoint, Internet Explorer, etc.

All candidates must be eligible to work in the United States without VISA sponsorship

Application Instructions:

We are an Equal Opportunity Employer. All persons shall have the opportunity to be considered for employment without regard to their race, color, age, sex, gender, religion, national origin, ancestry, citizenship status, physical or mental disability, military service, veteran status or any other characteristic protected by applicable federal, state or local law.

We will endeavor to make a reasonable accommodation to the known physical or mental limitations of a qualified applicant with a disability unless the accommodation would impose an undue hardship on the operation of our business. If you believe you require such assistance to complete this application or to participate in an interview, please let us know.

Note to Employment Agencies: Please do not forward agency resumes. CorVel Corporation is not responsible for any fees related to unsolicited resumes.

Please be aware that CorVel generally does not review all applications/resumes submitted in response to job openings posted on the Internet because of the large volume of responses

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Sr. Business Analyst Clinical & Payment Integrity

Corvel