Job Description
- 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
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