Concept Development Analyst (Automated Concepts)

Job description

Overview In the role of Concept Development Analyst (CDA) within our CCV business unit, you will support the enhancement and ongoing optimization of claim selection processes and tools, including AI-enabled methodologies. This role is primarily focused on applying deep clinical, coding, analytical, and reimbursement expertise to strengthen and operationalize existing selection strategies. Leveraging your knowledge of inpatient billing, you will contribute to improvements in proprietary claim selection tools that drive accurate, compliant, and scalable payment integrity outcomes. Your understanding of healthcare payment methodologies, coding behavior, and reimbursement rules is essential to ensuring selection methodologies align with real-world audit and billing practices. As the coding subject matter expert, you will partner closely with AI data scientists, analytics teams, and senior leaders, providing coding guidance, analytical insights, and validation to inform model development, tuning, and output evaluation. While this role may occasionally support the identification of new audit opportunities, its primary focus is on enabling model performance and selection effectiveness, ra...