Healthcare Coding Analyst

Job Summary

As a full-time Concept Development Analyst specializing in DRG, the candidate will support the enhancement of claim selection processes and tools, leveraging clinical and coding expertise to optimize payment integrity outcomes while collaborating with AI and analytics teams.

Key responsibilities

• Serve as a coding and billing subject matter expert, providing guidance to AI and analytics teams to inform model logic and outcomes
• Partner with data science teams to validate AI-enabled outputs for clinical accuracy and reimbursement appropriateness
• Analyze selection outputs and trends to support model tuning and identify data quality limitations impacting selection performance

Required qualifications

• Minimum of 5 years of experience in data analytics, medical billing, inpatient and outpatient coding, or auditing
• Bachelor's or Graduate degree required
• Proficiency in healthcare coding systems and payment methodologies (CPT, HCPCS, ICD-10, etc.)
• Proficiency in Microsoft Excel, including pivot tables and basic data analyses
• AAPC or AHIMA coding certification preferred