Concept and Edit Analyst, Data Mining

May 28, 2026

Other Jobs To Apply

No other job posts for this day.

Penstock is a service partner and SaaS builder for forward-thinking health plans and providers, empowering recovery, audit, and regulatory teams to get accuracy right from the start—when 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 all. Our business model is rooted in transparency and the drive to reinstate true integrity in payment integrity—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 and Edit Analyst serves as a subject matter expert responsible for the development, production auditing, validation, and continuous improvement of Penstock concepts and edits used to support claim selection across all claim, provider, and review types. This role is focused on ensuring that selection logic is not only analytically sound, but also effective, accurate, and actionable in a live production audit environment. A key responsibility of this position is to evaluate concept and edit performance through data mining, audit feedback, production results, and outcome analysis. The Concept and Edit Analyst identifies opportunities to improve logic accuracy, reduce non-actionable selections, strengthen audit yield, and ensure alignment with payment integrity objectives. This position partners closely with the Concept/Edit Development team, Audit team, Project team, and IT team to ensure that Penstock concepts and edits reliably identify coding, billing, and documentation errors that contribute to improper payments. By combining concept development expertise with production auditing oversight, this role helps drive consistent, high-quality, and defensible audit outcomes across all lines of review. Key responsibilities include: <ul> <li>Participates in the concept and edit development lifecycle, including researching new concepts, designing and refining selection logic, validating edits in production, documenting review criteria and rationale, and creating and maintaining associated production audits.</li> <li>Conducts data mining and analytical reviews to validate concept performance, identify trends and anomalies, and surface new recovery opportunities.</li> <li>Develops, maintains, and audits concept logic and applicable code sets to ensure alignment with intended business rules, reimbursement methodologies, and audit objectives.</li> <li>Serves as a dedicated production auditor, executing audits aligned to developed concepts and edits and ensuring accuracy, consistency, and quality in audit results.</li> <li>Develops and evaluates concepts and edits related to common payment integrity scenarios, including but not limited to: Frequency, Unit Based Concepts, etc. </li> <li>Researches and applies federal and state regulations, payor medical and administrative policies, provider contracts, and coding and billing standards to support concept integrity and defensibility.</li> <li>Analyzes audit and production results, identifies opportunities for concept or edit refinement, and updates logic and documentation as appropriate to improve performance.</li> <li>Partners with IT when system changes, data anomalies, or logic limitations are identified that may impact concept accuracy or audit execution.</li> <li>Assists with monthly claim selection and ongoing production support activities as needed.</li> <li>Contributes to and supports training efforts related to new or enhanced concepts and edits for the Audit team.</li> <li>Develops and utilizes analytical tools and reporting to monitor concept performance and drive continuous improvement.</li> <li>Stays current on coding, reimbursement, clinical, and industry changes that may impact existing concepts or inform new development opportunities.</li> <li>Provides subject matter expertise and guidance to Audit and Concept/Edit Development team members and supports broader payment integrity initiatives across the organization.</li> <li>Actively supports the Penstock mission by identifying and advancing high-quality, data-driven concepts and edits that promote accuracy, consistency, and integrity between payors and providers.</li> </ul> Qualifications and Education Requirements <ul> <li>Bachelor’s Degree in Health Informatics or Health Information Management, or equivalent formal education and experience </li> <li>Current AHIMA or AAPC coding credential(s)</li> <li>5 or more years of coding and/or auditing experience (or demonstrated equivalent)</li> <li>Experience with reimbursement policies and methodologies across different settings, such as inpatient, outpatient, skilled nursing, professional, etc. </li> <li>Experience with reviewing and interpreting federal and state rules and regulations, payor medical and administrative policies, provider contracts, and coding and billing standards</li> <li>Comprehensive understanding of Official Coding Guidelines, AHA Coding Clinic, and CPT assistant</li> <li>Experience, or familiarity, with structured query language (SQL) preferred</li> <li>Experience with collecting, analyzing, and interpreting claim and audit data </li> <li>Understanding of HIPAA, and all rules and practices regarding the safeguarding of PHI/PII</li> <li>Ability to communicate kindly and effectively with all levels of the organization</li> <li>Experience training, preparing, and delivering presentations</li> <li>Proficient with Microsoft Word, Excel, and PowerPoint</li> <li>Able to work Eastern time zone hours </li> <li>Secure and private home office with reliable high-speed internet connection</li> </ul> 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 better healthcare at a lower 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 <a href="https://hhfchealth1-my.sharepoint.com/personal/tcoskren_goodrootinc_com/Documents/Documents/People%20Strategy/Hiring/www.goodrootinc.com" rel="nofollow">www.goodrootinc.com</a>.

Back to blog

Common Interview Questions And Answers

1. HOW DO YOU PLAN YOUR DAY?

This is what this question poses: When do you focus and start working seriously? What are the hours you work optimally? Are you a night owl? A morning bird? Remote teams can be made up of people working on different shifts and around the world, so you won't necessarily be stuck in the 9-5 schedule if it's not for you...

2. HOW DO YOU USE THE DIFFERENT COMMUNICATION TOOLS IN DIFFERENT SITUATIONS?

When you're working on a remote team, there's no way to chat in the hallway between meetings or catch up on the latest project during an office carpool. Therefore, virtual communication will be absolutely essential to get your work done...

3. WHAT IS "WORKING REMOTE" REALLY FOR YOU?

Many people want to work remotely because of the flexibility it allows. You can work anywhere and at any time of the day...

4. WHAT DO YOU NEED IN YOUR PHYSICAL WORKSPACE TO SUCCEED IN YOUR WORK?

With this question, companies are looking to see what equipment they may need to provide you with and to verify how aware you are of what remote working could mean for you physically and logistically...

5. HOW DO YOU PROCESS INFORMATION?

Several years ago, I was working in a team to plan a big event. My supervisor made us all work as a team before the big day. One of our activities has been to find out how each of us processes information...

6. HOW DO YOU MANAGE THE CALENDAR AND THE PROGRAM? WHICH APPLICATIONS / SYSTEM DO YOU USE?

Or you may receive even more specific questions, such as: What's on your calendar? Do you plan blocks of time to do certain types of work? Do you have an open calendar that everyone can see?...

7. HOW DO YOU ORGANIZE FILES, LINKS, AND TABS ON YOUR COMPUTER?

Just like your schedule, how you track files and other information is very important. After all, everything is digital!...

8. HOW TO PRIORITIZE WORK?

The day I watched Marie Forleo's film separating the important from the urgent, my life changed. Not all remote jobs start fast, but most of them are...

9. HOW DO YOU PREPARE FOR A MEETING AND PREPARE A MEETING? WHAT DO YOU SEE HAPPENING DURING THE MEETING?

Just as communication is essential when working remotely, so is organization. Because you won't have those opportunities in the elevator or a casual conversation in the lunchroom, you should take advantage of the little time you have in a video or phone conference...

10. HOW DO YOU USE TECHNOLOGY ON A DAILY BASIS, IN YOUR WORK AND FOR YOUR PLEASURE?

This is a great question because it shows your comfort level with technology, which is very important for a remote worker because you will be working with technology over time...

DISCLAIMER