at Signature Performance, Inc. in Portland, Maine, United States
This is a remote based position. Applicants can be located nationwide
This position will serve as HIM consultant/subject matter expert for the development of ClaimsXM.
This position is expected to work closely with the development team and senior level client, partner and organizational leaders.
This position reports to the Vice President OF HIM services
Essential Job Functions include the following. Other duties may be assigned.
Will support the building, reviewing, testing and management of the claims clinical edit tool.
Initial work may include review of clinical edits, analyzing the current vs future state edits and other required analysis.
Conduct quality reviews throughout the initial 90 days after Go-Live and as directed thereafter.
Based on clinical coding expertise, assist with development, implementation and review of Fraud, Waste and Abuse tools to assure accurate claims processing.
Develop internal training, knowledge share content for peer to peer mentoring/knowledge share
Participate during project planning, assessment/workflow process, direct build progress of teams (or own team), development of testing plans, Parallel processes (user acceptance testing) and go live activities.
Participates in client communication process to develop and enhance client understanding of the project Best Practice, project timelines, tasks, client commitment, risk/issue impacts and mitigation.
Completes project tasks and assignments independently with general supervision
Use professional knowledge and experience to advise on optimal workflows and system functions.
Navigate across venues to resolve issues, propose mitigation strategies, and escalate when appropriate to solution and engagement leadership
Works closely with users to identify problems and provide solutions. Demonstrates an understanding of users' needs.
Analyzes reasonably complex issues and develops/implements solutions with general guidance.
Uses knowledge to facilitate client workflow and gap analysis, independently with general guidance to complete documentation utilizing department standards.
Understands project deliverables and level of effort to complete and monitors own effort to stay within project level of effort definition.
Provides weekly status reports
Knowledge & Experience:
Minimum 3 years experience required. Prefer 5-10 years of senior level experience.
Auditing, consulting or analysis experience preferred.
CPC, RHIA or RHIT certification. Other AAPC or AHIMA certifications will be considered.
Preferred knowledge of and/or experience with VA processes and systems.
Must have excellent verbal and written communication skills.
Ability to interact with all levels of clients and management.
Excellent computer skills including Microsoft Office suite.
Must be a highly motivated individual able to grasp complex technologies, tools and concepts and learn quickly.
Work in accordance with corporate and organizational security policies and procedures, understand personal role in safeguarding corporate and client assets, and take appropriate action to prevent and report any compromises of security within scope of position.
Must have a demonstrated ability to work within tight deadlines and under pressure.
Able to communicate technical verbiage in language and terms that are easy for the layperson to understand.
General Areas of Accountability
Must conduct business and personal affairs in a manner that is always a credit to the company.
Machines and Equipment:
The incumbent must be able to effectively operate the current computer system, telephone system, and other office machines such as copier and fax machines.
The incumbent must be able to finger, grasp, feel, see, sit, hear, and speak. This position is sedentary in nature with minimal lifting requirements.
The incumbent works in an office environment that is not substantially exposed to adverse environmental conditions such as heat, cold, or extreme noise. Routine periods of being on the phone utilizing a headset, sitting and data keying are required.
The above statements are intended to describe the general nature of work being performed by people assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of personnel so classified.
Remote Eligibility: This position is full-time remote eligible. Eligibility is determined by Management or Human Resources.
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