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CGI Technologies and Solutions, Inc. New Concepts and Edits Development Specialist in Cleveland, Ohio

New Concepts and Edits Development Specialist

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New Concepts and Edits Development Specialist

Category: Business Analysis (functional and technical)

City: Cleveland, Ohio, US United States

Position ID: J1221-2730

Employment Type: Full Time

Position Description:

The New Concepts and Edits Specialist is a member of the CGI Payment Integrity Audit Team, with responsibility for identifying new concepts and edits for the purpose of creation of payment integrity audits. The New Concepts and Edits Specialist is charged with researching reimbursement regulations, payment guidelines, healthcare provider contracts, and health insurance industry guidance’s to create edit concepts which when implemented may result in identification of improper payments on paid claims on behalf of Clients (health insurers).

The New Concepts and Edits Specialist has a sound knowledge base in edit research and development in pre-pay and retrospective medical claims auditing. Edits are developed through a well-defined process which requires the Edit Specialist to incorporate clinical experience, knowledge, and critical thinking skills in order to assess available information and render a recommendation. Edits will be developed for various Provider types and ranges of clinical services, including but not limited to acute care, outpatient, DME, Home Care, Skill Nursing, Long Term Acute Care and other care settings.

The New Concepts and Edits Specialist reports to the Audit Team Manager, who provides support, feedback, and guidance to the Edit Specialist.

Your future duties and responsibilities:

• Work closely with Artificial Intelligence teams (either vendor or CGI internal) to further streamline the edit development processes.

Required qualifications to be successful in this role:

The New Concepts and Edits Specialist is a Registered Nurse (RN) with active, unrestricted licensure through the Board or Agency charged with providing such licensure in the Auditor’s state of residence and/or RHIA/RHIT/CCS certified through the American Health Information Management Association. BS in Nursing and/or Health Information Management required. Previous pre-pay or post-payment auditing experience required (Minimum 5 years).

Must have good working knowledge and experience of the different types of pay structures (fee schedule, POC, etc.) and how those can influence recovery opportunities

Minimum Education Required: Associates Degree (RHIT); Bachelors degree preferred and at least one of the following professional certifications: CCS-P, CPC, CPC-H/COC

DESIRED QUALIFICATIONS/NON-ESSENTIAL SKILLS REQUIRED

Previous payment integrity edits development experience (1- 3 years) preferred.

Est. Salary Range (Colorado Only): $68k-$109k*

*Disclaimer: In accordance with Colorado’s Equal Pay for Equal Work Act, effective January 1, 2021, a good faith hourly or base salary range must be posted for all positions where the work may be performed in the state of Colorado. Therefore, this good faith salary range will only apply where this described position will be performed in the state, and should not be considered the compensation range in other locations or for other positions.

At CGI we call our professionals members to reinforce that all who join our team are, as owners, empowered to participate in the challenges and rewards that come from building a world-class company. CGIs benefits include:

Competitive base salaries

Eligibility to participate in an attractive Share Purchase Plan (SPP) in which the company matches dollar-for-dollar contributions made by eligible employees, up to a maximum, for their job category

401(k) Plan and Profit Participation for eligible members

Generous holidays, vacation, and sick leave plans

Comprehensive insurance plans that include, among other benefits, medical, dental, vision, life, disability, out-of-county emergency coverage in all countries of employment;

Back-up child care, Pet insurance, a Member Assistance Program, a 529 college savings program, a personal financial management tool, lifestyle management programs and more

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Skills:

  • Auditing (Claims)

  • Registered Nurse (RN)

What you can expect from us:

Build your career with us.

It is an extraordinary time to be in business. As digital transformation continues to accelerate, CGI is at the center of this change—supporting our clients’ digital journeys and offering our professionals exciting career opportunities.

At CGI, our success comes from the talent and commitment of our professionals. As one team, we share the challenges and rewards that come from growing our company, which reinforces our culture of ownership. All of our professionals benefit from the value we collectively create.

Be part of building one of the largest independent technology and business services firms in the world.

Learn more about CGI at www.cgi.com .

No unsolicited agency referrals please.

CGI is an equal opportunity employer.

Qualified applicants will receive consideration for employment without regard to their race, ethnicity, ancestry, color, sex, religion, creed, age, national origin, citizenship status, disability, pregnancy, medical condition, military and veteran status, marital status, sexual orientation or perceived sexual orientation, gender, gender identity and gender expression, familial status, political affiliation, genetic information, or any other legally protected status or characteristics.

CGI provides reasonable accommodations to qualified individuals with disabilities. If you need an accommodation to apply for a job in the U.S., please email the CGI U.S. Employment Compliance mailbox at USEmploymentCompliance@cgi.com . You will need to reference the requisition number of the position in which you are interested. Your message will be routed to the appropriate recruiter who will assist you. Please note, this email address is only to be used for those individuals who need an accommodation to apply for a job. Emails for any other reason or those that do not include a requisition number will not be returned .

We make it easy to translate military experience and skills! Click here to be directed to our site that is dedicated to veterans and transitioning service members.

All CGI offers of employment in the U.S. are contingent upon the ability to successfully complete a background investigation. Background investigation components can vary dependent upon specific assignment and/or level of US government security clearance held. Qualified applicants with arrest and conviction records are welcome to apply.

CGI will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with CGI’s legal duty to furnish information.

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