Sr. Claims Coding Analyst

Sr. Claims Coding Analyst

Requirements

• Coding certification from either American Academy of Professional Coders (AAPC), Certified Professional Coders (CPC) or American Health Information Management Association (AHIMA)
• Previous Coding work experience
• High school diploma or GED from an accredited institution

Responsibilities

• Analyze and interpret health insurance benefits and coverage details to apply appropriate medical codes.
• Accurately assign procedure (CPT, HCPCS) and diagnosis codes (ICD-10) represent patient services, treatments, copays, and coinsurance
• Verify coding accuracy to support compliant billing and prevent claim denials and accurate claim adjudication
• Collaborate with clinical, claims and benefits teams to clarify appropriate claim coverage and denials as published within the plan materials
• Maintain up-to-date knowledge of coding guidelines, insurance policies, and industry regulations
• Support audits, compliance checks, and quality assurance initiatives to ensure coding accuracy
• Provide coding guidance and training for other team members as needed
• Additional duties as assigned

Preferred Qualifications

• 5-10 years of experience in medical coding, with a focus on benefits and insurance-related coding
• Prior experience with LCDs, NCDs and Medicaid coverage determinations
• Prior experience with multiple Medicare and Medicaid physician, hospital, AMB Surgery, DME, vaccination Ambulance fee schedules
• Prior experience with multiple claims scrubbers to ensure coding guidelines are followed
• Prior experience in a health insurance plan
• Prior experience in New York Medicaid Insurance Plans
• Bachelor’s degree in related field
• Time management, critical/creative thinking, communication, and problem-solving skills
• Demonstrated professional writing, electronic documentation, and assessment skills
• Intermediate Outlook, Basic Word, Excel, PowerPoint, Adobe Acrobat skills
• Knowledge of anatomy and pathophysiology medical terminologies