Coding Analyst II

This is a fully remote position, open to applicants in Arizona, +16 more states.

📋 Description

• Review and code clinical documentation utilizing ICD, CPT, HCPCS, and internal coding standards.

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

• Investigate any missing or ambiguous information to ensure correct code assignments.

• Conduct timely coding reviews to support accurate claims processing.

• Audit claims, encounters, and documentation to identify coding errors or discrepancies.

• Analyze coding patterns to uncover trends, risks, and gaps that may impact payment accuracy.

• Document audit findings and suggest corrective measures.

• Communicate audit results to internal stakeholders.

• Examine how coding affects claims adjudication, reimbursement, and provider disputes.

• Collaborate with configuration, operations, and provider teams to address coding challenges.

• Verify coding rules within system logic and highlight any discrepancies.

• Assist in issue triage workflows.

• Apply coding regulations, payer guidelines, and organizational policies.

• Maintain compliance with regulatory, audit, and documentation standards.

• Engage in coding quality and process enhancement initiatives.

• Monitor updates to coding rules and assist in implementing necessary changes.

• Mentor junior analysts on coding practices, documentation standards, and audit techniques.

• Aid in training, documentation revisions, and knowledge sharing.

• Carry out other duties as assigned.

⛳️ Requirements

• Bachelor's degree in Health Information Management, Healthcare Administration, Business, or a related field, or an equivalent blend of education and experience.

• Over 3 years of professional experience in coding for a health plan, insurance payer, facility, and/or hospital post-degree.

• Required coding certification: CCA, CPC-P, CPC, CPC-H, CCS, CCS-P, RHIT, or RHIA.

• Familiarity with revenue codes, NUBC guidelines, UB-04 claim requirements, DRGs, and facility reimbursement methods.

• Experience in analyzing medical coding and claim data.

• Understanding of the impact of coding on claims adjudication, provider reimbursement, and payment precision.

• Proficient in researching and interpreting coding guidelines, industry standards, and healthcare billing requirements.

• Possess analytical and problem-solving abilities to investigate coding issues and determine root causes.

• Capable of tracking trends and identifying opportunities for process improvements.

• Strong written and verbal communication skills.

• Must reside in a state where Medica is registered as an employer: AR, AZ, FL, GA, IA, IL, KS, KY, MI, MN, MO, ND, NE, OK, SD, TN, TX, VA, or WI.

• Must have legal authorization to work in the United States at the time of application.

• Medica does not provide work visa sponsorship.

🏝️ Benefits

• Competitive medical insurance.

• Dental insurance.

• Vision insurance.

• Paid Time Off (PTO).

• Holidays.

• Paid volunteer time off.

• 401K contributions.

• Caregiver services.

• Additional total rewards benefits.