Sr Content Integrity Lead in Work From Home at MultiPlan

Date Posted: 9/29/2022

Job Snapshot

Job Description

Imagine a workplace that encourages you to interpret, innovate and inspire. Our employees do just that by helping healthcare payers manage the cost of care, improve competitiveness and inspire positive change. You can be part of an established company with a 40-year legacy that helps our customers thrive by interpreting our client's needs and tailoring innovative healthcare cost management solutions.

Our commitment to diversity, inclusion and belonging are part of the fabric of our company.  We strive to create a workplace that fosters mutual respect and collaboration, where every talented individual can participate and perform their best work.  We are MultiPlan and we are where bright people come to shine!  

JOB SUMMARY:
This role will partner with senior operations management to set strategic and operational goals that drive revenue across the data mining operations platform in the areas of content integrity, including user acceptance testing (UAT) on data and content. This individual will establish goals for staff development, data/concept integrity and other activities needed to drive financial and cost objectives of the company.
JOB ROLES AND RESPONSIBILITIES:

1. Draft, set, and implement strategies for process efficiencies to ensure content integrity in line with Client service level agreements (SLA's).
2. Measure, monitor, and provide consistent feedback and reports on content accuracy through KPIs.
3. Work with business partners, including but not limited to, Implementation, IT, Content, Operations, to define system requirements and solve any inefficiencies in processes.
4. Deploy measures to ensure auditors maintain accurate, up to date status code dispositions in the overpayment tracking tool.
5. Apply analytics and data mining techniques to client paid claims data to ensure company financial metrics are met.
6. Review medical claims in payer system to determine methods of payment and validate savings identified and communicate to the audit team to drive financial goals.
7. Utilize expertise for internal and client facing discussions on relevant Coordination of Benefits operational items.
8. Assist with the efficient onboarding of new clients and ensure the operations team is knowledgeable on all new client specifications and processes.
9. Assist the executive departmental leadership on strategy and growth initiatives which may include but not limited to, special projects.
10. Ensure systematic data-oriented efforts to improve consumer and/or client services.
11. Collaborate, coordinate, and communicate across disciplines and departments.
12. Ensure compliance with HIPAA regulations and requirements.
13. Demonstrate Company's Core Competencies and values held within.
14. Please note due to the exposure of PHI sensitive data -- this role is considered to be a High Risk Role.
15. The position responsibilities outlined above are in no way to be construed as all encompassing. Other duties, responsibilities, and qualifications may be required and/or assigned as necessary.
JOB SCOPE:
The incumbent relies upon a broad knowledge base of principles, practices, and procedures within the field while working under limited supervision to complete the job responsibilities. This role requires the incumbent work independently while having a firm grasp on analytical procedure knowing how to outline complex events and help others understand and implement them. The work performed within this role is often be varied and complex in nature. The work performed also directly impacts client results across the team and therefore has a dramatic impact on the revenue produced across the team. Individual will be expected to keep senior leadership abreast of any identified financial risks/opportunities that may have a strong effect on company performance.

Job Requirements

JOB REQUIREMENTS (Education, Experience, and Training):
* Minimum high school diploma plus four (4) years' direct experience in claims data mining. Bachelors' degree in a relevant field along with a medical coding certification is preferred.
* Advanced knowledge of coding type edits and medical claim reimbursement structures and methodologies
* Advanced proficiency with medical terminology, medical procedures, medical conditions, and illness and treatment practices
* Extensive experience in applying principles of coding guidelines; federal/state regulations and policies pertaining to coding and billing
* Subject matter expert in reviewing and interpreting medium to complex medical contracts
* Extensive knowledge in researching state and federal healthcare guidelines, i.e. Medicare and State Medicaid Programs
* Familiarity with automated medical claims payment systems and/or working knowledge of payer systems (i.e. Facets, QNXT, etc.)
* Excellent organizational, analytical, and independent decision-making skills.
* Demonstrated problem solving skills with the ability to manage multiple priorities and meet associated timelines.
* Ability to anticipate needs and solve problems proactively in a fast paced, rapidly changing environment.
* Ability to learn quickly and work independently within time constraints.
* Adept knowledge of Microsoft Word, Excel, and Outlook; Excel proficiency required (pivot tables, VLOOKUP, data analysis and data reporting).
* Logical, clear, and concise written and verbal communication skills.
* Required licensures, professional certifications, and/or Board certifications as applicable
* Individual in this position must be able to work in a standard office environment which requires sitting and viewing monitor(s) for extended periods of time, operating standard office equipment such as, but not limited to, a keyboard, copier and telephone

BENEFITS

 

We realize that our employees are instrumental to our success, and we reward them accordingly with very competitive compensation and benefits packages, an incentive bonus program, as well as recognition and awards programs. Our work environment is friendly and supportive, and we offer flexible schedules whenever possible, as well as a wide range of live and web-based professional development and educational programs to prepare you for advancement opportunities.

Your benefits will include:

  • Medical, dental, and vision coverage (low copay & deductible)
  • Life insurance
  • Short- and long-term disability
  • 401(k) + match
  • Generous Paid Time Off
  • Paid company holidays
  • Tuition reimbursement
  • Flexible Spending Account
  • Employee Assistance Program
  • Summer Hours

 

[FOR POSITIONS THAT CAN WORK FROM HOME]

**Pursuant to Colorado’s “Equal Pay for Equal Work Act”, the following salary range is provided solely for applicants living in Colorado.  ($70-75K).  If an applicant does not live in Colorado, this salary range may not apply.  Specific offers take into account a candidate’s education, experience and skills, as well as the candidate’s work location and internal equity.  This position is also eligible for health insurance, 401k and bonus opportunity.

 

EEO STATEMENT

MultiPlan is an Equal Opportunity Employer and complies with all applicable laws and regulations. Qualified applicants will receive consideration for employment without regard to age, race, color, religion, gender, sexual orientation, gender identity, national origin, disability or protected veteran status. If you’d like more information on your EEO rights under the law, please click here.

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