Provide subject matter expertise in healthcare coding, classification systems, and regulatory requirements
Develop a deep understanding of Medicaid and healthcare coding methodologies (i.e. CPT, HCPSC and applicable state-specific codes)
Support organizational compliance and operational accuracy by maintaining current knowledge of coding and reimbursement requirements
Ensure codes accurately reflect services for claims acceptance through the claims adjudication and encounter reporting processes
Partner closely with Provider Relations to enter new codes and modify existing codes in the EMR systems
Create accurate reporting of adequacy and other contract-required metrics
Research claim denials, identifying root causes related to coding, and collaborating with appropriate teams to resolve issues
Work with the Data Analytics team to define, store, and analyze data needed to generate meaningful reports

Proficiency in medical coding systems including CPT and HCPCS
Certification from AAPC or equivalent (e.g., CPC, CRC, CCS, or CCS-P) or AHIMA is preferred
Minimum of three (3) years of experience with healthcare coding, preferably within Medicaid or managed care environments
Associate or bachelor’s degree in health information management, Healthcare Management, Statistics, or related field is preferred
Competent in using Microsoft software including Excel; experience with data tools (SQL) and healthcare systems (EMR/HER platforms) knowledge desired
Strong analytical and critical thinking skills, with the ability to research, interpret, and resolve misalignments related to coding
Current driver’s license, acceptable driving record, and proof of adequate insurance required

Coding Analyst

Key skills