Coding Analyst

🕒 Julho 28

🌾 Nebraska, Minnesota, +2 estados a mais – Remoto

🌾 Nebraska – Remote ❄️ Minnesota – Remote 🏰 Missouri – Remote 🧀 Wisconsin – Remote

💵 $45.900 - $68.775 / ano

⏰ Tempo Integral

🟡 Pleno

🟠 Sênior

🧐 Analista

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Medica

SiteLinkedInTodas as Vagas

1001 - 5000 funcionários

Fundada em 1975

🏥 Saúde

🛡️ Seguros

⚕️ Seguro de Saúde

Healthcare • Insurance • Healthcare Insurance

A Medica é uma organização sem fins lucrativos de planos de saúde e seguradora com mais de 50 anos de experiência, que oferece planos individuais e familiares, Medicare, Medicaid e planos de saúde fornecidos por empregadores. Ela oferece serviços aos membros e ferramentas para encontrar prestadores de serviços, gerenciar benefícios e reivindicações, programas de bem-estar e iniciativas focadas na comunidade através da Medica Foundation para promover a equidade em saúde.

Descrição

• Apply Medical Coding Standards to Claims & Clinical Documentation • Review and code clinical documentation using ICD, CPT, HCPCS, and internal coding guidelines. • Validate coding accuracy to support compliant billing, reimbursement, and data reporting. • Research missing or unclear information to ensure proper code assignment. • Complete timely coding reviews that enable accurate claims processing. • Conduct Coding Reviews & Identify Discrepancies • Perform audits of claims, encounters, and documentation to detect coding errors or inconsistencies. • Analyze coding patterns to identify trends, risks, or gaps affecting payment accuracy. • Document findings clearly and recommend corrective actions that reduce recurrence. • Communicate audit results to internal partners, ensuring clarity, professionalism, and follow-through. • Troubleshoot Coding-Related Issues Across Operational Processes • Investigate coding impacts on claims adjudication, reimbursement, and provider disputes. • Collaborate with configuration, operations, and provider teams to resolve issues efficiently. • Verify coding rules within system logic and flag discrepancies for correction. • Support issue triage workflows that improve operational stability and payment accuracy. • Support Coding Quality, Compliance, & Documentation Standards • Apply coding regulations, payer guidelines, and organizational policies consistently. • Maintain compliance with regulatory requirements, audit standards, and documentation expectations. • Participate in coding quality initiatives that strengthen accuracy and reduce rework. • Monitor updates to coding rules and support implementation of required changes. • Serve as a Knowledge Resource & Contribute to Team Objectives • Provide guidance to junior analysts on coding practices, documentation requirements, and audit methods. • Assist with training, documentation updates, and knowledge‑sharing within the team. • Participate in process improvement efforts that enhance coding workflows and accuracy. • Contribute to team goals by delivering reliable expertise, consistent quality, and timely work. • Other duties as assigned.

🎯 Requisitos

• Bachelor's degree or equivalent experience in related field • 3+ years of medical coding experience within a Health Plan or Payment Integrity department • Current professional coding certification from a nationally recognized credentialing organization • Acceptable certifications may include, but are not limited to, CPC, CPC-H (COC), CCS, CCS-P, RHIT, or RHIA • Certification must be maintained in good standing throughout employment. • Certified Professional Coder (CPC) and Certified Outpatient Coder (COC) coding certifications are highly preferred. • Experience supporting coding-related system configuration, business rules, or claims processing logic. • Experience serving 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 Microsoft Excel skills, including data analysis, sorting, filtering, comparisons, pivot tables, and formulas. • Ability to work successfully in a remote work environment with minimal supervision.

🏖️ Benefícios

• competitive medical, dental, vision • PTO • Holidays • paid volunteer time off • 401K contributions • caregiver services