Medical Codebook Analyst (Plexis Quantum Choice)

Codebook/Plexis Quantum Choice Analyst

GDIT is seeking a detail-oriented and technically proficient Codebook/Plexis Quantum Choice Analyst to support the World Trade Center (WTC) Health Program. In this critical role, you will manage the integrity of clinical and financial data within the Plexis Quantum Choice platform, ensuring that WTC responders and survivors receive accurate benefits and care coordination. You will be the bridge between clinical coding requirements and system functionality, maintaining the "Codebook" that drives claim accuracy and program compliance.

Responsibilities for this Position:

• 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.

What You'll Need to Succeed: Minimum Qualifications

• 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.
• Must have 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.
• Must have a deep understanding of medical terminology, medical coding (ICD-10/CPT), and reimbursement methodologies (DRGs/HCC).
• Knowledge of HIPAA compliance and federal health program standards.

Preferred Qualifications:

• Prior experience supporting the World Trade Center Health Program or other federal government health contracts.
• Professional certification such as CPC (Certified Professional Coder) or CHDA (Certified Health Data Analyst).
• Strong analytical mindset with the ability to translate complex clinical rules into technical system requirements

Gdit Is Your Place:

• 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