Sr. Business Analyst Clinical & Payment Integrity

Corvel Baltimore , MD 21203

Posted 2 months 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

#CB

  • MON*
icon no score

See how you match
to the job

Find your dream job anywhere
with the LiveCareer app.
Mobile App Icon
Download the
LiveCareer app and find
your dream job anywhere
App Store Icon Google Play Icon
lc_ad

Boost your job search productivity with our
free Chrome Extension!

lc_apply_tool GET EXTENSION

Similar Jobs

Want to see jobs matched to your resume? Upload One Now! Remove
IFS Automation Business Analyst Sr Manager

Pwc

Posted 2 weeks ago

VIEW JOBS 11/21/2019 12:00:00 AM 2020-02-19T00:00 A career in National Special Functions, within Internal Firm Services, will provide you with the opportunity to support service, sector, and market leaders deliver the unique PwC client experience to our clients. You'll play an important part in continuously innovating and improving Firm operations so that we can continue to provide the highest quality of services to our current and prospective clients. Our Global Delivery Model Services team is responsible for developing programs and initiatives directed at designing, developing, and implementing a robust Business Process Management Solutions Platform to enable effective scalability and sound management of PwC's Global Delivery Model operations on a worldwide scale. To really stand out and make us ?t for the future in a constantly changing world, each and every one of us at PwC needs to be an authentic and inclusive leader, at all grades/levels and in all lines of service. To help us achieve this we have the PwC Professional; our global leadership development framework. It gives us a single set of expectations across our lines, geographies and career paths, and provides transparency on the skills we need as individuals to be successful and progress in our careers, now and in the future. As a Senior Manager, you'll work as part of a team of problem solvers, helping to solve complex business issues from strategy to execution. PwC Professional skills and responsibilities for this management level include but are not limited to: - Take action to ensure everyone has a voice, inviting opinion from all. - Establish the root causes of issues and tackle them, rather than just the symptoms. - Initiate open and honest coaching conversations at all levels. - Move easily between big picture thinking and managing relevant detail. - Anticipate stakeholder needs, and develop and discuss potential solutions, even before the stakeholder realises they are required. - Develop specialised expertise in one or more areas. - Advise stakeholders on relevant technical issues for their business area. - Navigate the complexities of global teams and engagements. - Build trust with teams and stakeholders through open and honest conversation. - Uphold the firm's code of ethics and business conduct. Job Requirements and Preferences: Basic Qualifications: Minimum Degree Required: High School Diploma Minimum Years of Experience: 6 year(s) Preferred Qualifications: Degree Preferred: Bachelor Degree Preferred Fields of Study: Business Administration/Management, Computer and Information Science, Industrial Engineering, Economics, Statistics Certification(s) Preferred: Business Analysis Professional (CBAP), Project Management (PMP), Six Sigma Black Belt, Lean, Kaizen or Certified Certified Professional Engineer (PE). Preferred Knowledge/Skills: Demonstrates intimate abilities and/or a proven record of success as a team leader in the following areas: * Creating detailed business analysis, outlining problems, opportunities and solutions for a business; * Analyzing and managing projects by defining and achieving project outcomes and meeting project key performance metric targets; * Staying up-to-date on the latest process and IT advancements to automate and modernize systems; * Conducting meetings and presentations to share ideas and findings; * Identifying, creating and facilitating process design changes by conducting business and systems process analysis and design at a complex level; * Focusing on quality improvement and data management; * Establishing data is reliable and valid as well as developing process improvements or re-engineering and recommending elimination; * Understanding efforts in all Lines of Service (LoS) and the firms strategy by integrating new systems and processes with existing ones as well as and partnering with internal and external teams to establish systems provided meet the long-term business strategies; * Managing and documenting changes in project scope, identify potential risks, devise contingency plans; * Defining Definition of Ready (DOR) and Definition of Done (DOD) for the Team and establishing they are met; * Creating accurate models of business processes using BPMN that reflects current and desired state; * Understanding and capturing requirements where necessary as well as owning the Change Management Process; * Establishing a successful collaboration model with business leadership teams and functional leadership teams; * Presenting at meetings and conferences to create awareness of product strategy and generating excitement for future business opportunities; * Providing valuable stakeholder feedback to address and taking action to meet the firm's strategic goals; * Representing stakeholders and setting product and project vision; * Managing/coaching small multidisciplinary product teams and collaborating with designers, business users, and developers to innovate and drive product development; * Being the voice to the Build team as well as working with geographically distributed teams; * Producing visual prototype and functional prototypes with agile approaches; * Demonstrating effective collaboration with teams spanning multiple geographies; * Collaborating with constituents to generate proposals and helping to manage deployment of offshore based resources to deliver engagements; * Employing operational excellence methodologies such as Lean, Kaizen, Six Sigma, Benchmarking, etc. to advance the value of services; * Creating Current/Future state VSMs to discover opportunities ad help business leaders derive value by employing technology to automate end-to-end processes; * Streamlining, optimizing, and structuring mature processes for successful automation; * Possessing project management skills, managing multiple tasks at any given point, and communication skills; * Utilizing proven written, verbal, and interpersonal skills with aptitude to understand and solve problems; * Managing multiple tasks and assigned projects as well as building relationships and influencing decisions; * Demonstrating ability to solve complex problems with keen instincts and organizational experience; * Coordinating/integrating resources with the Tech Team, keep the pipeline updated; and, * Working independently with minimal supervision; and display decision making skills. All qualified applicants will receive consideration for employment at PwC without regard to race; creed; color; religion; national origin; sex; age; disability; sexual orientation; gender identity or expression; genetic predisposition or carrier status; veteran, marital, or citizenship status; or any other status protected by law. PwC is proud to be an affirmative action and equal opportunity employer. For positions based in San Francisco, consideration of qualified candidates with arrest and conviction records will be in a manner consistent with the San Francisco Fair Chance Ordinance. Pwc Baltimore MD

Sr. Business Analyst Clinical & Payment Integrity

Corvel