Coding Analyst

This is a fully remote position, open to applicants in Nebraska, +3 more states.

📋 Description

• Implement Medical Coding Standards for Claims and Clinical Documentation.

• Review and code clinical documents in accordance with ICD, CPT, HCPCS, and internal coding guidelines.

• Ensure coding accuracy to facilitate compliant billing, reimbursement, and data reporting.

• Investigate missing or ambiguous information to guarantee appropriate code assignment.

• Conduct timely coding reviews to support precise claims processing.

• Execute Coding Reviews and Identify Discrepancies.

• Perform audits on claims, encounters, and documentation to uncover coding errors or inconsistencies.

• Analyze coding trends to identify risks or gaps that may affect payment accuracy.

• Clearly document findings and suggest corrective measures to minimize recurrence.

• Relay audit results to internal stakeholders with clarity, professionalism, and thorough follow-up.

• Resolve Coding-Related Issues Across Operational Processes.

• Assess the impact of coding on claims adjudication, reimbursement, and provider disputes.

• Collaborate with configuration, operations, and provider teams for efficient issue resolution.

• Verify coding regulations within system logic and highlight discrepancies for correction.

• Facilitate issue triage workflows to enhance operational stability and payment accuracy.

• Uphold Coding Quality, Compliance, and Documentation Standards.

• Consistently apply coding regulations, payer guidelines, and organizational policies.

• Ensure compliance with regulatory mandates, audit standards, and documentation expectations.

• Participate in coding quality initiatives aimed at improving accuracy and minimizing rework.

• Stay updated on coding rule changes and assist in implementing necessary adjustments.

• Act as a Knowledge Resource and Contribute to Team Objectives.

• Offer guidance to junior analysts on coding practices, documentation standards, and auditing techniques.

• Aid in training, documentation revisions, and knowledge sharing within the team.

• Engage in process improvement initiatives that enhance coding workflows and accuracy.

• Contribute to team objectives by delivering reliable expertise, maintaining consistent quality, and producing timely work.

• Perform additional duties as assigned.

⛳️ Requirements

• Bachelor's degree or equivalent experience in a related field.

• Minimum of 3 years of medical coding experience in a Health Plan or Payment Integrity department.

• Current professional coding certification from a nationally recognized credentialing body.

• Acceptable certifications may include, but are not limited to, CPC, CPC-H (COC), CCS, CCS-P, RHIT, or RHIA.

• Certification must be kept in good standing throughout the duration of employment.

• Certified Professional Coder (CPC) and Certified Outpatient Coder (COC) certifications are highly preferred.

• Experience supporting coding-related system configurations, business rules, or claims processing logic.

• Proven experience as a subject matter expert for cross-functional stakeholders.

• Familiarity with coding and reimbursement platforms, such as Optum EncoderPro, Optum CES, HealthRules, or similar healthcare technologies.

• Intermediate proficiency in Microsoft Excel, including skills in data analysis, sorting, filtering, comparisons, pivot tables, and formulas.

• Ability to thrive in a remote work environment with minimal supervision.

🏝️ Benefits

• Competitive medical, dental, and vision coverage.

• Paid time off (PTO).

• Paid holidays.

• Paid volunteer time off.

• 401K contributions.

• Caregiver services.