Medical Billing Compliance Analyst I

Under general direction, the Compliance Analyst, will use their knowledge of medical coding and billing guidelines and regulations, including compliance and reimbursement, to manage and understand issues such as medical necessity, claims denials, and authorizations. You will report to our Senior Director Compliance Data.

They are responsible for the accurate representation of medical rules/edits from any source. Coding competencies required for accurate representation for CPT(r), HCPCS Level II, and ICD-10-CM Medical Codes

Job Responsibilities:

• Extracts information from resources and translates information needed to form appropriate logic for rules.
• Identify necessary and potential changes to existing medical rules through the review of current and historically available medical policies, transmittals and bulletins.
• 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 in appropriate table(s) (ICD-10, CPT/HCPCS, CCI_Edits)
• Review of National Coverage Determinations for PPH National policies, assigning appropriate diagnosis and procedural codes for incorporation into Medicare Medical Edits.
• Builds and maintain data and medical rules tables for multiple Experian Health products in Microsoft Access.
• Independently reviews, prepares and make appropriate adjustments to data editorial for release to production.
• Independently completes production data release process.
• Complete in-depth, independent review of support cases, responding to and discussing with clients as necessary.
• Responsible for timely and accurate research of resources that update critical information on a scheduled basis. Stay informed about current coding issues.

Experian is a global data and technology company, powering opportunities for people and businesses around the world. We help to redefine lending practices, uncover and prevent fraud, simplify healthcare, create marketing solutions, and gain deeper insights into the automotive market, all using our unique combination of data, analytics and software. We also assist millions of people to realize their financial goals and help them save time and money.

We operate across a range of markets, from financial services to healthcare, automotive, agribusiness, insurance, and many more industry segments.

We invest in people and new advanced technologies to unlock the power of data. As a FTSE 100 Index company listed on the London Stock Exchange (EXPN), we have a team of 22,500 people across 32 countries. Our corporate headquarters are in Dublin, Ireland. Learn more at experianplc.com.

• Experience with and knowledge of Current Procedural Terminology (CPT) Coding, and International Classification of Disease (ICD-10) Codes required
• Ability to understand and retain coding information and transfer that information into completed product data.
• Knowledge of Medical Terminology
• Knowledge of anatomy and physiology
• Knowledge of Medicare reimbursement guidelines
• Research, analyze and draw conclusions regarding medical edits
• Prior experience in developing medical policy edits
• Previous Healthcare experience
• Prior experience in developing medical policy edits desired
• Previous experience as an outpatient Medical Coder is a plus

Educational requirements:

Associate's or Bachelor's degree in the Life Sciences or Accredited Record Technician's certification (ART) or Certified Procedural Coder certificate (CPC) or a combination of training, education and experience that is equivalent to the standards listed and that provides the required knowledge and abilities

This is a permanent home-based role in Costa Rica. No Visa sponsorship or relocation available.**

Our benefits include: Medical, life and dental insurance, Asociación Solidarista, International Share Save Plan, Flex Work/Work from home, Paid time off, Annual Performance Bonus, Education Reimbursement, Family Bonding, Bereavement Leave, Referral Program, and more.

Experian is proud to be an Equal Opportunity and Affirmative Action employer. Our goal is to create a successful, inclusive and diverse team where people love their work and love working together. We believe that diversity, equity and inclusion is important to our purpose of creating a better tomorrow. We value the uniqueness and want you to bring your whole, authentic self to work. For us, this is The Power of YOU and it ensures that we live what we believe.

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This is a remote position.