Clinical Coding Analyst, Senior

Your Work

As a Clinical Coding Analyst-Senior, you will be responsible for implementing a new code governance framework and maintaining industry-standard code updates across multiple systems. Conducts research and prepares files in compliance with member benefit language, contracts, and regulatory mandates. Develops and maintains policies and procedures while responding to regulatory inquiries and providing recommendations for accurate payment applications.

Your Role

In this role you will:

• Manage the Code Load process, ensuring expert guidance in industry-standard code release integration with multiple systems
• Research and prepare files using industry standard codes that meet the intent of regulatory mandates set forth by the state or federal agencies
• Research, develop and maintain payment policies based on industry or expert supported research
• Provide problem management recommendations on correct application of payment based on industry and internal research
• Reviewing medical records and claims for coding accuracy.
• Ensuring compliance with ICD-10, CPT, and HCPCS coding guidelines.
• Conducting audits to verify proper billing and reimbursement.
• Collaborating with cross functional departments to resolve coding discrepancies.
• Staying updated on regulatory changes affecting medical coding.

Your Knowledge and Experience

• Requires an AA degree at minimum
• AHIMA Certified CCS required
• AAPC Certified CPC a plus
• Requires 5-8 years of directly related professional experience and possesses deep technical abilities
• Strong analytical and problem-solving skills
• Intermediate proficiency in Microsoft Excel, Word, and PowerPoint.
• Requires advanced knowledge of job area typically obtained through advanced education combined with experience