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

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills & Tools

SQLExcelICD-10CPTHCPCSdata analysisclinical codingclaims system configurationdata reportingUAT

Soft Skills

troubleshootingdata-driven solutionscollaborationdocumentationproblem-solving

Certifications

CPCCHDA