CPC Certified Coding Analyst

Job Summary

Providing clinical leadership and subject-matter expertise, the full-time remote Health Services Coding Analyst (CPC Certified Coding Analyst) will analyze, configure, and administer complex medical policy content within claims processing systems while mentoring Coding Specialists and collaborating with various operational teams.

Key responsibilities

• Lead the analysis and implementation of complex medical policy content and system edits to ensure compliance and accurate claims adjudication
• Translate complex medical policy language into actionable coding criteria for integration into claims systems
• Serve as a subject matter expert for coding-related issues, collaborating with Utilization Management and claims teams to resolve denials and policy interpretation questions

Required qualifications

• Certified Professional Coder (CPC) required
• Associate degree or direct and applicable work experience preferred
• Clinical background in a health-related discipline or direct work experience in a clinical setting
• 7+ years of related healthcare experience in provider payment, claims, or medical coding
• Demonstrated expertise in medical coding and terminology