Certified Coding Analyst

Job Summary

Supporting the Pre-Pay Claims Validation product, the remote Coding Quality Analyst will perform complex clinical coding reviews, identify inaccuracies, and collaborate with partners to enhance claim accuracy and compliance.

Key responsibilities:

• Conduct clinical reviews of professional claims and medical records to ensure compliance with coding and documentation requirements
• Analyze claim data to identify discrepancies and investigate findings for various customer types
• Maintain documentation of review findings and provide clear rationales for determinations

Required qualifications:

• High School Diploma/GED
• Certified coder (CPC, COC, CPMA, CCS) or Nursing Licensure
• 2+ years of experience in healthcare claims auditing and multi-specialty coding
• Proficiency in Microsoft applications (OneNote, Teams, Excel, Outlook)
• 2+ years of experience in Evaluation and Management Services coding