Research Analyst by Enterprise IT Solution

Research Analyst

by 

Enterprise IT Solution

Posted on 13-May-2013

• Location(s)Bangalore
• Experience3 to 6 Yrs

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Job Description

Functional AreaR&D / Product Design

IndustryMedical / Healthcare

Skills Required:

Certified with CPC/CCS.
Should have hands on experience in-5.10 years
The NCCI-national correct coding initiative-5
CMS derivatives, manuals & transmittals (cms- constant maturity swap)
The medicare physician fee schedule- 
The CMS national laboratory fee schedule 
The HCPCS coding system & directives (Healthcare common procedure coding system)
The CPT coding guidelines & conventions. -5
National medicalspeciality society & coding guidelines.

Job Summary:

Responsible for conducting atatistical analysis & reviewing federal & state statutes, regulations, provider manuals, bulletins & other sources to identify potential fraud, waste & abuse.

Roles & Responsibilities: 

Responsible for doing research on assigned speciality project related to Medicare, Medicacid, facility & professional regulations. 
Perform detailed analysis on clinical data, comparison reports & state regulationsfor each state-specific edit on payer or state specific requirements. 
Review documentation of Federal Edit Base rules on an annual basis for annual updates & changes per CMS 
Provide coding, billing & regulatory expertise as it relates to practical application of company edits & analytics to client claims
Review all available sources including federal & state statutes, regulations, provider manuals & bulletins for changes to and/or new payment rules. 
Identify & mark changes to and/or new payment rules or language in the source document which may be utilized to update existing system edits & new system edits.