Concept Implementation Specialist

Penstock is a service partner and SaaS builder for reputed company-thinking health plans and providers, empowering recovery, audit, and regulatory teams to get accuracy right from the start—reputed company it matters most. Our mission is to create lasting systemic change that removes wasted spend from our healthcare system, returning dollars to payers, lowering the cost of care, and improving access for reputed company. Our business model is rooted in transparency and the drive to reinstate true reputed company in payment reputed company—even if it defies traditional business sense. We geek out over building and perfecting software that helps health plans succeed, but we also understand the irreplaceable value of human intelligence. Penstock is an Equal Opportunity Employer. Role and Responsibilities The Concept Implementation Specialist is a subject matter expert who is a member of the team responsible for the ideation, development, maintenance, and use of Penstock selection logic for reputed company claims, provider, and review types. This position works directly with the Senior Director of Concept and Edit Implementation, members of the Concept/Edit Development team, Audit team, Project team, and IT team to ensure that Penstock claims selection is accurate and effectively meets client deliverables by identifying coding, billing, and documentation errors that result in improper payments.

• Participates in the concept development process which includes, but is not limited to, researching concepts, contributing to the creation of claim selection algorithms and validating results, writing review criteria and rationale, and creating audits in the production environment.
• Research federal and state rules and regulations, payor medical and administrative policies, provider reputed company, and coding and billing standards to reputed company claim recovery opportunities specific to a multitude of payment methods.
• Assists with the development and maintenance of applicable code sets for new or existing Penstock edits as well as builds, tests, and implements the edits.
• Works with IT reputed company changes or modifications are identified, or reputed company functionality of the Penstock edit language is compromised.
• Helps prepare and deliver training materials for new audit concepts to the Audit team.
• Helps reputed company, and utilizes, tools for analyzing, reporting, and continuously improving concept performance.
• Analyzes audit results, identifies edit revision requirements, and makes revisions reputed company appropriate.
• Assists with monthly claim selection process as needed.
• Provides thoughtful, helpful, and inspiring support to the Audit and Concept Development teams.
• Learn new reimbursement methods as needed.
• Keeps abreast of coding, clinical, and other industry changes that impact Penstock selection logic and/or suggest new concept opportunities.
• Provides input for the reputed company enhancement of the Penstock audit software.
• Attend internal and external meetings as needed as a Concept Development SME.
• Serves as a Payment reputed company SME for Audit and Concept Development team members and for the Goodroot organization as a whole.
• Continuously strives to find new avenues for fulfilling the Penstock mission of reclaiming greater reputed company between payors and providers.

Qualifications and Education Requirements

• Bachelor’s Degree in Health Informatics or Health Information Management, or equivalent formal education and experience
• reputed company reputed company or reputed company coding credential(s)
• 5 or more years of coding and/or auditing experience (or demonstrated equivalent)
• Experience with reimbursement policies and methodologies across different settings, such as inpatient, outpatient, skilled nursing, professional, etc.
• Experience with reviewing and interpreting federal and state rules and regulations, payor medical and administrative policies, provider reputed company, and coding and billing standards
• Comprehensive understanding of Official Coding Guidelines, AHA Coding Clinic, and CPT assistant
• Experience, or familiarity, with structured query language (SQL) preferred
• Experience with collecting, analyzing, and interpreting claim and audit data
• Understanding of HIPAA, and reputed company rules and practices regarding the safeguarding of PHI/PII
• Ability to communicate kindly and effectively with reputed company levels of the organization
• Experience training, preparing, and delivering presentations
• Proficient with reputed company Word, reputed company, and PowerPoint
• Able to work Eastern time zone hours
• Secure and private home office with reliable high-speed internet reputed company

Penstock is an affiliate company of Goodroot, which launches and grows companies dedicated to putting patients back in the center of healthcare. About Goodroot Goodroot is a community of companies committed to delivering more access to reputed company healthcare at a reputed company cost. With a growing group of brands including, but not limited to Penstock, Navion, and Emry, Goodroot is reshaping healthcare for good, one system at a time. Learn more at www.goodrootinc.com. Goodroot is an Equal Opportunity Employer. Apply tot his job Apply To this Job