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Analyst, Concept Optimization

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POST DATE 8/10/2016
END DATE 10/19/2016

Cotiviti USA, LLC Blue Bell, PA

Blue Bell, PA
AJE Ref #
Job Classification
Full Time
Job Type
Company Ref #
Mid-Career (2 - 15 years)
Bachelors Degree



The Concept Analyst is part of our concept development team and works directly with concept developers to ensure that data mining reports return results consistent with the types of medical claims intended to be included in the report. The goal of the position is to ensure that all potentially overpaid claims are captured on the auditing reports with minimal amount of false positives (claims paid correctly).

Key Responsibilities

* Edit Parameter Development. Works in conjunction with concept developers to create edit parameters that are incorporated into data mining reports in order to identify medical claims that meet concept logic. Identifies opportunities to refine report criteria to enhance the result set while ensuring maximum concept coverage.

* Report Validation. Reviews medical claims that qualify for reports to ensure that claims fall within the universe of claims intended to be captured on the report based. Works with Business Analysts to validate that SQL statements are accurate. Works with subject matter experts to identify report modifications that are required to improve accuracy and efficiency of auditing reports.

* Report Implementation. Works with local audit teams as an integral part of report implementation. Serves as the liaison between the audit s subject matter experts and the business analysts. Work with key constituents to establish effective feedback on audit results.

* Gap Analysis. Compares edit parameters across multiple reports to identify inconsistencies that would lead to different results. Works with subject matter experts to identify standard edit parameters where inconsistencies exist. Works with business analyst to implement report modifications and ensure that report results are accurate.



* Bachelor s degree required

* Minimum of 2 years of related, claim auditing experience and process mapping experience.

* Working knowledge of medical claims processing and reimbursement, including facility and professional claims

* Knowledge of CPT codes, procedure codes, revenue codes, and DRGs

* Strong knowledge of Microsoft Access

* Ability to understand SQL statements and identify results to ensure consistent with SQL statements

* We are an Equal Opportunity Employer.

* Please view Equal Employment Opportunity Posters provided by OFCCP here.

* Cotiviti is an Equal Opportunity Employer. The Company provides equal employment opportunities to all applicants for employment without regard to gender, sexual orientation or preference, gender identity or expression, race, color, religion, national origin, ethnicity, ancestry, age, marital status, pregnancy, childbirth or related medical conditions, mental or physical disability, veteran status or any other characteristic protected by federal, state or local law, ordinance or regulation..

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, or national origin. We are also an equal opportunity employer of individuals with disabilities and protected veterans. Please view Equal Employment Opportunity Posters provided by OFCCP here.