Certified Coding Analyst

Job Summary

Serving as a Medical Coding subject matter expert, the full-time remote Program Integrity Coding & Research Analyst will analyze complex provider claims submissions, resolve coding issues, and oversee quality audits while collaborating with various stakeholders.

Key responsibilities:

• Analyze complex provider claims submissions using CPT, ICD10, HCPCS, and DRG coding rules
• Lead root cause analysis of provider claim issues and oversee quality audit programs for internal coding validation
• Develop and implement an annual audit plan for high-risk providers, ensuring compliance and accuracy in claims processing

Required qualifications:

• Bachelor's degree in Business Administration or related field, or equivalent relevant work experience
• Seven (7) years of experience in medical coding, including program integrity coding audits
• Five (5) years of experience with Medicaid policy development and analysis preferred
• Experience with reimbursement methodologies such as APC, DRG, and OPPS required
• Certified Professional Coder (CPC) or equivalent billing/coding designation required