Clinical Operations Analyst, Medical Coding

📋 Description

• Assist in the creation and execution of clinical protocols, standard operating procedures (SOPs), and medical policies.

• Review medical records and develop design language to ensure accurate code assignments and regulatory compliance.

• Assess treatment plans and perform audits on large claims to pinpoint any discrepancies.

• Collaborate with underwriting and stop-loss teams to provide coding insights and conduct risk assessments.

• Aid clinical operations in the management and analysis of clinical program data.

• Serve as a reliable consultant across the organization, offering guidance and training on coding practices and clinical standards.

⛳️ Requirements

• Successful completion of a medical coding certification program.

• Bachelor’s degree in Nursing, Health Information Management, or a similar field of study.

• Over 5 years of experience in medical coding, including at least 2 years in a health plan, third-party administrator (TPA), or managed care organization.

• In-depth knowledge of anatomy, medical terminology, and coding systems, along with experience using coding software and electronic health records (EHRs).

• Proven ability to analyze data, recognize trends, and support decision-making concerning fraud, waste, and abuse, while demonstrating the capacity to exercise independent judgment.

🏝️ Benefits

• Coverage for alternative medicine.

• Generous paid time off (PTO).

• Up to 16 weeks of paid parental leave.

• Paid holidays.

• 401k retirement plan.

• Transportation benefits.

• Education reimbursement.

• Paid paw-ternity leave.