Claims Coding Analyst

HealthPartners • Bloomington, MN

8d

About The Position

HealthPartners is hiring a Claims Coding Analyst to provide expert support in medical coding compliance, claims adjudication accuracy, and coding system integrity. The role ensures that claims processing systems accurately reflect industry-standard coding requirements, including CPT, HCPCS, ICD-9, ICD-10, and related code sets. The analyst supports regulatory and policy changes, evaluates coding-related claim issues, and identifies billing trends and errors. The position partners with internal stakeholders and external vendors to maintain coding system functionality and support accurate reimbursement and compliance outcomes.

Requirements

• Completion of a medical coding program with an AAPC- or AHIMA-equivalent certification (CPC, CCA, CCS), or ability to obtain certification within one year.
• At least 2 years of coding experience across multiple patient visit types.
• Experience in claims processing and medical billing within healthcare or insurance settings.
• Experience with HMO, fully insured, indemnity, and government programs.
• Demonstrated ability to make independent decisions in claim coding and adjudication.
• CPC, CCA, CCS, or equivalent certification, required or to be obtained within one year of hire.
• Strong knowledge of CPT, HCPCS, ICD-10, revenue codes, and claim formats (837P/837I).
• Understanding of medical terminology, anatomy, physiology, and disease processes.
• Knowledge of Coordination of Benefits (COB) rules, including Medicare regulations.
• Experience using claims processing systems, encoder tools, and coding software.
• Strong analytical, problem-solving, and trend analysis skills.
• Solid organizational and planning capabilities.
• Proficiency in Microsoft tools and data analysis.
• Ability to communicate effectively with internal stakeholders and external parties.

Nice To Haves

• Bachelor’s degree in a related field.
• 5 or more years of experience in the healthcare industry.
• Advanced or specialty coding certifications.
• Experience with claims processing systems.
• Strong familiarity with coding governance, reimbursement methodologies, and audit processes.

Responsibilities

• Review and evaluate claims for coding accuracy and medical appropriateness.
• Approve or deny claims based on coding guidelines and policy requirements.
• Resolve claim processing errors related to code validation during adjudication.
• Ensure compliance with HIPAA and industry coding standards across claim types.
• Monitor CMS, NUBC, and other regulatory bodies for coding updates.
• Support implementation, testing, and validation of coding system updates.
• Maintain and support coding systems, including vendor-managed platforms such as ClaimCheck.
• Ensure system configuration aligns with current coding requirements.
• Analyze coding-related claim issues to identify billing trends, errors, and opportunities.
• Recommend enhancements or corrections for identified billing trends, errors, and opportunities.
• Conduct research to support new code implementation or policy changes.
• Evaluate coding business rules and recommend enhancements or corrections.
• Perform trend analysis to support business decision-making.
• Serve as a subject matter expert for coding questions across the organization.
• Act as a key point of contact for claims, provider appeals, and adjustment requests.
• Communicate coding review outcomes to members and providers when appropriate.
• Support cross-functional teams, including claims, sales, and contracting.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed