Licensed Clinical Coding Analyst

Job Summary

Providing support to Clinical Policy, the full-time Licensed Clinical Coding Analyst will ensure the accuracy of coding for Clinical Coverage Guidelines (CCGs) and Claims Edit Guidelines (CEGs) while working remotely.

Key responsibilities

• Directs the review and updates of coding in CCGs to support medical necessity reviews and leads revisions to CEGs
• Conducts research on evidence-based criteria and authorization rules to support clinical decision-making
• Oversees the hand-off of CCGs and CEGs to the Coding Integrity team for final review and implementation of necessary edits

Required qualifications

• Associate's Degree in a related field or equivalent experience
• 4+ years of experience in the medical coding field with a facility, provider, or payer organization
• Knowledge of Medicare and Medicaid regulations
• Licensure as a Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), Certified Coding Specialist (CCS), Certified Coding Specialist Provider-based (CCS-P), or Certified Professional Coder (CPC or CPC-H)