New Concepts and Edits Development Specialist
Company: CGI Group, Inc.
Posted on: May 16, 2022
New Concepts and Edits Development Specialist
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
The New Concepts and Edits Specialist reports to the Audit Team
Manager, who provides support, feedback, and guidance to the Edit
Your future duties and responsibilities
- Work closely with Artificial Intelligence teams (either vendor
or CGI internal) to further streamline the edit development
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
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
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
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
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 US_Employment_Compliance@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. CGI will consider for employment qualified
applicants with arrests and conviction records in accordance with
all local regulations and ordinances.
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.
Keywords: CGI Group, Inc., Cleveland , New Concepts and Edits Development Specialist, Other , Cleveland, Ohio
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