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Coding Analyst II

🕒 September 16

🌵 Arizona, Florida, +15 more states – Remote

infoinfo

💵 $45.9k - $68.8k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🧐 Analyst

Where this job comes from

Posted on Medica's careers page, not through a job board

First seen by Remote Rocketship September 16

Still open on Medica's site. Checked 11 hours ago.

Logo of Medica

Medica

1001 - 5000 employees

Founded 1975

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

Medica is a nonprofit health plan and insurer with over 50 years of experience that provides individual & family plans, Medicare, Medicaid, and employer-provided health plans. It offers member services and tools for finding providers, managing benefits and claims, wellness programs, and community-focused initiatives through the Medica Foundation to advance health equity.

📋 Description

• Review and code clinical documentation using ICD, CPT, HCPCS, and internal coding guidelines • Validate coding accuracy for compliant billing, reimbursement, and data reporting • Research missing or unclear information for proper code assignment • Complete timely coding reviews for accurate claims processing • Audit claims, encounters, and documentation to detect coding errors or inconsistencies • Analyze coding patterns to identify trends, risks, and gaps affecting payment accuracy • Document audit findings and recommend corrective actions • Communicate audit results to internal partners • Investigate coding impacts on claims adjudication, reimbursement, and provider disputes • Collaborate with configuration, operations, and provider teams to resolve coding issues • Verify coding rules within system logic and flag discrepancies • Support issue triage workflows • Apply coding regulations, payer guidelines, and organizational policies • Maintain compliance with regulatory requirements and audit standards • Participate in coding quality initiatives and monitor coding-rule updates • Provide guidance to junior analysts • Assist with training, documentation updates, and knowledge-sharing • Participate in process improvement efforts and contribute to team goals

🎯 Requirements

• Bachelor's degree in Health Information Management, Healthcare Administration, Business, or a related field, or equivalent combination of education and experience • 3+ years of work experience beyond degree in coding for a health plan, insurance payer, facility and/or hospital • Coding certification required: CCA, CPC-P, CPC, CPC-H, CCS, CCS-P, RHIT, or RHIA • Knowledge of revenue codes, NUBC guidelines, UB-04 claim requirements, DRGs, and facility reimbursement methodologies • Experience analyzing medical coding and claim data to determine appropriate coding, payment, and reimbursement outcomes • Understanding of coding impacts on claim adjudication, provider reimbursement, and payment accuracy • Experience researching and interpreting coding guidelines, industry standards, and healthcare billing requirements • Analytical and problem-solving skills for investigating coding issues and identifying root causes • Ability to track trends and recommend process improvements • Strong written and verbal communication skills • Primary home address within 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 be legally authorized to work in the United States at application • Medica does not offer work visa sponsorship

🏖️ Benefits

• Competitive medical, dental, and vision benefits • PTO • Holidays • Paid volunteer time off • 401K contributions • Caregiver services • Other total rewards benefits

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