Senior Claims Coding Analyst

This is a fully remote position, open to applicants in Connecticut, +2 more states.

📋 Description

• Act as the triage coordinator for provider disputes and ascertain suitable resolution pathways.

• Examine dispute populations to pinpoint trends, root causes, and opportunities for cost-effective resolutions.

• Conduct independent coding analyses and resolve complex claims, disputes, and appeals.

• Recognize high-volume and high-cost dispute situations and formulate population-level solutions.

• Suggest and assist in modifications to claims edits, configurations, payment policies, workflows, automation, and provider education.

• Collaborate with Claims, Provider Operations, Configuration, Technology, Payment Integrity, and various stakeholders.

• Track dispute volume, overturn and repeat rates, turnaround time, administrative costs, and resolution outcomes.

• Serve as an expert in coding and payment policy.

• Review medical records as necessary to determine proper coding and claim disposition.

• Communicate coding and payment determinations to providers and internal stakeholders.

• Lead ongoing improvement initiatives to minimize avoidable disputes and administrative costs.

• Provide daily guidance and mentorship to Claims Coding Analysts.

• Undertake additional duties and special projects as assigned.

⛳️ Requirements

• Completion of a coding class and/or certification from AAPC or AHIMA, including CPC or equivalent.

• Prior professional coding and/or claims payment experience on both the payer and provider sides.

• Experience in researching and applying coding guidelines to complex claims or provider disputes.

• Capability to independently analyze claims and disputes and make defensible coding and payment decisions.

• High school diploma or GED from an accredited institution.

• Bachelor’s degree in a related field is preferred.

• Experience with provider disputes, claims operations, claims editing, claims configuration, or healthcare operations analytics is preferred.

• Familiarity with anatomy, medical terminology, CPT, HCPCS, ICD-10, CMS, and New York State coding and payment regulations is preferred.

🏝️ Benefits

• Medical, dental, and vision coverage.

• Incentive and recognition programs.

• Life insurance.

• 401k contributions.

• Competitive compensation and benefits package.