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Job Details

Compliance Data Analyst

Company name
Experian Information Solutions, Inc.

Location
Schaumburg, IL

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Compliance Data Analyst

Experian

Schaumburg

IL

Job #631215438

Description

At Experian Health, our employees have the opportunity to shape more than products – they shape the future of U.S. healthcare. Experian Health is a pioneer for innovations leading the way in revenue cycle management, identity management, patient engagement, and care management for hospitals, physician groups, labs, pharmacies and other risk-bearing entities. Our success relies on people who are given the freedom to imagine new frontiers in the rapidly changing healthcare space and push the boundaries of innovation. Help us realize our vision of applying data for good and changing the healthcare landscape for the better – for all of us.

At Experian Health we understand that your life extends beyond the workplace. We value our employees and offer a robust suite of benefits including health and wellness, time off, volunteer opportunities and retirement plans. These are designed to keep our employees at the top of their game and inspired to be a part of the Experian Health team.

Medical, Dental, Vision and Life Insurance

401K with immediate 100% vesting

Vacation and 10 paid holidays

Employee Assistance Program

Short-Term and Long Term Disability Coverage

Flexible Spending Accounts

Tuition Reimbursement Program

The Compliance Data Analyst is responsible for the accurate representation of medical rules/edits from any source. Additionally, the Data Specialist is responsible for building and utilizing the HMEDICAR table and Revenue Code tables, Claims Transaction Engine (CTE) tables and interacting with clients regarding Technical Support Issues identified. The Data Specialist may review and make recommendations regarding Level I coding, placement, and logic.

Primary responsibilities will include:

Identify necessary and potential changes to existing medical rules through review of current and historically available hardcopy medical policies, transmittals and bulletins. This includes but is not limited to revision and retirement of existing policies and the addition of new policies.

Extracts information from resources and translates information needed to form appropriate logic for rules. Also responsible for HMEDICAR table build, documentation and Quality Assurance review. Completes CTE table builds, review and complete integrity checks for multiple software products as these edits are used, or modified, for varying levels of ICD-9-CM review and Medical Necessity checking.

Completes reviews of medical policies and publications and its integration into the required database on a timely basis. Identifies patterns of improper coding or errors in policies and publications and is able to resolve and recommend alternate codes, or code representation is appropriate table(s) (Diagnosis, CPT/HCPCS, CCI_Edits)

Prepares documentation and reviews as needed with the Director. Reviews forwarded Technical Support information/documentation for completeness and accuracy. Composes responses and discusses with clients if necessary.

Knowledge, Experience & Qualifications

Associate’s or Bachelor’s degree in the Life Sciences or Accredited Record Technician’s certification (ART) or Certified Procedural Coder certificate (CPC)

Experience with Current Procedural Terminology (CPT) Coding, and International Classification of Disease (ICD-9/10) Codes required.

Ability to understand and retain coding information, and transfer that information into completed product data.

Ability to maintain effective working relationships is essential

Knowledge of Medical Terminology, anatomy and physiology

Knowledge of Medicare reimbursement guidelines

Prior experience in developing medical policy edits desired

Must be able to exercise independent judgment

Previous Healthcare required

Previous experience as an outpatient Medical Coder is a plus

Experian is the leading global information services company, providing data and analytical tools to our clients around the world. We have always believed that data has the potential to transform lives and create a better tomorrow. We are transforming data into something meaningful: helping businesses to manage credit risk, preventing fraud, targeting marketing offers and automating decision making. We have been named one of the “World’s Most Innovative Companies” by Forbes for 3 years in a row, operating at the center of Big Data since before the phrase was coined. Few companies can offer information services on an equivalent scale. We support clients in more than 80 countries and employ approximately 17,000 people in 37 countries.

Experian is an Equal Opportunity Employer. Anyone needing accommodation to complete the interview process should notify the talent acquisition partner. The word Experian is a registered trademark in the EU and other countries and is owned by Experian Ltd. and/or its associated companies.

Description

At Experian Health, our employees have the opportunity to shape more than products – they shape the future of U.S. healthcare. Experian Health is a pioneer for innovations leading the way in revenue cycle management, identity management, patient engagement, and care management for hospitals, physician groups, labs, pharmacies and other risk-bearing entities. Our success relies on people who are given the freedom to imagine new frontiers in the rapidly changing healthcare space and push the boundaries of innovation. Help us realize our vision of applying data for good and changing the healthcare landscape for the better – for all of us.

At Experian Health we understand that your life extends beyond the workplace. We value our employees and offer a robust suite of benefits including health and wellness, time off, volunteer opportunities and retirement plans. These are designed to keep our employees at the top of their game and inspired to be a part of the Experian Health team.

Medical, Dental, Vision and Life Insurance

401K with immediate 100% vesting

Vacation and 10 paid holidays

Employee Assistance Program

Short-Term and Long Term Disability Coverage

Flexible Spending Accounts

Tuition Reimbursement Program

The Compliance Data Analyst is responsible for the accurate representation of medical rules/edits from any source. Additionally, the Data Specialist is responsible for building and utilizing the HMEDICAR table and Revenue Code tables, Claims Transaction Engine (CTE) tables and interacting with clients regarding Technical Support Issues identified. The Data Specialist may review and make recommendations regarding Level I coding, placement, and logic.

Primary responsibilities will include:

Identify necessary and potential changes to existing medical rules through review of current and historically available hardcopy medical policies, transmittals and bulletins. This includes but is not limited to revision and retirement of existing policies and the addition of new policies.

Extracts information from resources and translates information needed to form appropriate logic for rules. Also responsible for HMEDICAR table build, documentation and Quality Assurance review. Completes CTE table builds, review and complete integrity checks for multiple software products as these edits are used, or modified, for varying levels of ICD-9-CM review and Medical Necessity checking.

Completes reviews of medical policies and publications and its integration into the required database on a timely basis. Identifies patterns of improper coding or errors in policies and publications and is able to resolve and recommend alternate codes, or code representation is appropriate table(s) (Diagnosis, CPT/HCPCS, CCI_Edits)

Prepares documentation and reviews as needed with the Director. Reviews forwarded Technical Support information/documentation for completeness and accuracy. Composes responses and discusses with clients if necessary.

Knowledge, Experience & Qualifications

Associate’s or Bachelor’s degree in the Life Sciences or Accredited Record Technician’s certification (ART) or Certified Procedural Coder certificate (CPC)

Experience with Current Procedural Terminology (CPT) Coding, and International Classification of Disease (ICD-9/10) Codes required.

Ability to understand and retain coding information, and transfer that information into completed product data.

Ability to maintain effective working relationships is essential

Knowledge of Medical Terminology, anatomy and physiology

Knowledge of Medicare reimbursement guidelines

Prior experience in developing medical policy edits desired

Must be able to exercise independent judgment

Previous Healthcare required

Previous experience as an outpatient Medical Coder is a plus

Experian is the leading global information services company, providing data and analytical tools to our clients around the world. We have always believed that data has the potential to transform lives and create a better tomorrow. We are transforming data into something meaningful: helping businesses to manage credit risk, preventing fraud, targeting marketing offers and automating decision making. We have been named one of the “World’s Most Innovative Companies” by Forbes for 3 years in a row, operating at the center of Big Data since before the phrase was coined. Few companies can offer information services on an equivalent scale. We support clients in more than 80 countries and employ approximately 17,000 people in 37 countries.

Experian is an Equal Opportunity Employer. Anyone needing accommodation to complete the interview process should notify the talent acquisition partner. The word Experian is a registered trademark in the EU and other countries and is owned by Experian Ltd. and/or its associated companies.

Experian is an Equal Opportunity Employer

Updated 04/14/2018

Company info

Experian Information Solutions, Inc.
Website : http://www.experian.com/

Company Profile
We are the leading global information services company, providing data and analytical tools to our clients around the world. We help businesses to manage credit risk, prevent fraud, target marketing offers and automate decision making. We also help people to check their credit report and credit score, and protect against identity theft. In 2015, we were named by Forbes magazine as one of the “World’s Most Innovative Companies.” We employ approximately 17,000 people in 37 countries and our corporate headquarters are in Dublin, Ireland, with operational headquarters in Nottingham, UK; California, US; and São Paulo, Brazil. Experian plc is listed on the London Stock Exchange (EXPN) and is a constituent of the FTSE 100 index. Total revenue for the year ended March 31, 2015, was US$4.8 billion.

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