Senior Claims Coding Analyst

🔥 17 hours ago

🦌 Connecticut, New Jersey, +1 more states – Remote

🦌 Connecticut – Remote 🏖️ New Jersey – Remote 🗽 New York – Remote

💵 $73.4k - $120.4k / year

⏰ Full Time

🟠 Senior

🧐 Analyst

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Healthfirst

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1993

🛡️ Insurance

🏥 Healthcare

⚕️ Healthcare Insurance

Insurance • Healthcare • Healthcare Insurance

Healthfirst is a health insurance provider dedicated to helping New Yorkers access affordable health coverage for individuals and families. With over 30 years of experience, Healthfirst offers a range of plans including Medicaid managed care, Medicare Advantage, long-term care, and essential health plans. The company focuses on providing quality healthcare options, comprehensive benefits, and support to ensure members can maintain their health and well-being.

📋 Description

• Serve as a triage coordinator for provider disputes and determine appropriate resolution pathways • Analyze dispute populations to identify trends, root causes, and lower-cost resolution opportunities • Perform independent coding analysis and disposition complex claims, disputes, and appeals • Identify high-volume and high-cost dispute scenarios and develop population-level solutions • Recommend and support changes to claims edits, configuration, payment policies, workflows, automation, and provider education • Partner with Claims, Provider Operations, Configuration, Technology, Payment Integrity, and other stakeholders • Monitor dispute volume, overturn and repeat rates, turnaround time, administrative cost, and resolution outcomes • Serve as a coding and payment policy subject matter expert • Review medical records as needed to determine appropriate coding and claim disposition • Communicate coding and payment decisions to providers and internal stakeholders • Lead continuous improvement efforts to reduce avoidable disputes and administrative expense • Provide day-to-day guidance and mentorship to Claims Coding Analysts • Perform additional duties and special projects as assigned

🎯 Requirements

• Coding class completion and/or certification from AAPC or AHIMA, including CPC or equivalent • Previous professional coding and/or claims payment experience on both payer and provider side • Experience researching and applying coding guidelines to complex claims or provider disputes • Ability 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 preferred • Experience with provider disputes, claims operations, claims editing, claims configuration, or healthcare operations analytics preferred • Knowledge of anatomy, medical terminology, CPT, HCPCS, ICD-10, CMS, and New York State coding and payment requirements preferred

🏖️ Benefits

• Medical, dental and vision coverage • Incentive and recognition programs • Life insurance • 401k contributions • Competitive compensation and benefits package