Medical Codebook Analyst – Plexis Quantum Choice
Job Description:
• Maintain and update the Quantum Choice "Codebook," including the loading of contract terms, benefit structures, and reference tables specific to WTC Health Program guidelines.
• Perform regular audits of clinical codes (ICD-10, CPT, HCPCS) to ensure they align with the WTC Health Program’s covered conditions and regulatory mandates.
• Lead User Acceptance Testing (UAT) for system enhancements and upgrades; identify, document, and track software bugs or configuration errors.
• Partner with clinical teams and claims processors to troubleshoot complex adjudication issues and provide data-driven solutions for benefit plan updates.
• Utilize SQL or advanced Excel to generate reports on system performance, data accuracy, and program utilization for leadership.
Requirements:
• Associate of Arts (AA) or Associate of Science (AS) degree. (Bachelor’s degree in Health Informatics, IT, or a related field preferred).
• 5+ years of professional experience in healthcare data analysis, clinical coding, or claims system configuration.
• Extensive experience with Plexis Quantum Choice (or similar platforms like QNXT).
• Strong proficiency in Microsoft Excel (v-lookups, pivot tables) and basic SQL query knowledge.
• Deep understanding of medical terminology, medical coding (ICD-10/CPT), and reimbursement methodologies (DRGs/HCC).
• Knowledge of HIPAA compliance and federal health program standards.
• Prior experience supporting the World Trade Center Health Program or other federal government health contracts is preferred.
• Professional certification such as CPC (Certified Professional Coder) or CHDA (Certified Health Data Analyst) is preferred.
Benefits:
• 401K with company match
• Comprehensive health and wellness packages
• Internal mobility team dedicated to helping you own your career
• Professional scientific growth opportunities, including journal subscriptions, conference attendance, and supporting publication journey
• Cutting-edge technology you can learn from
• Rest and recharge with paid vacation and holidays
Apply Now
Apply Now
• Maintain and update the Quantum Choice "Codebook," including the loading of contract terms, benefit structures, and reference tables specific to WTC Health Program guidelines.
• Perform regular audits of clinical codes (ICD-10, CPT, HCPCS) to ensure they align with the WTC Health Program’s covered conditions and regulatory mandates.
• Lead User Acceptance Testing (UAT) for system enhancements and upgrades; identify, document, and track software bugs or configuration errors.
• Partner with clinical teams and claims processors to troubleshoot complex adjudication issues and provide data-driven solutions for benefit plan updates.
• Utilize SQL or advanced Excel to generate reports on system performance, data accuracy, and program utilization for leadership.
Requirements:
• Associate of Arts (AA) or Associate of Science (AS) degree. (Bachelor’s degree in Health Informatics, IT, or a related field preferred).
• 5+ years of professional experience in healthcare data analysis, clinical coding, or claims system configuration.
• Extensive experience with Plexis Quantum Choice (or similar platforms like QNXT).
• Strong proficiency in Microsoft Excel (v-lookups, pivot tables) and basic SQL query knowledge.
• Deep understanding of medical terminology, medical coding (ICD-10/CPT), and reimbursement methodologies (DRGs/HCC).
• Knowledge of HIPAA compliance and federal health program standards.
• Prior experience supporting the World Trade Center Health Program or other federal government health contracts is preferred.
• Professional certification such as CPC (Certified Professional Coder) or CHDA (Certified Health Data Analyst) is preferred.
Benefits:
• 401K with company match
• Comprehensive health and wellness packages
• Internal mobility team dedicated to helping you own your career
• Professional scientific growth opportunities, including journal subscriptions, conference attendance, and supporting publication journey
• Cutting-edge technology you can learn from
• Rest and recharge with paid vacation and holidays
Apply Now
Apply Now