Coding Analyst (Wisconsin Based - Remote)

Lakeland Care Incorporated•Fond Du Lac, WI

2d•Remote

About The Position

Under the general supervision of the Data Analytics Manager, the Coding Analyst provides subject matter expertise in all areas related to healthcare coding, classification systems and regulatory requirements that support accurate service documentation, claims processing and organizational compliance. The Coding Analyst is responsible for developing a deep understanding of Medicaid and healthcare coding methodologies (i.e. CPT, HCPSC and applicable state-specific codes) and their application across long term care, managed care and community-based service delivery models. This role supports organizational compliance and operational accuracy by maintaining current knowledge of coding and reimbursement requirements, monitoring ongoing changes, and ensuring all updates from regulatory bodies, including state agencies and payer partners are communicated effectively to internal stakeholders. This role will support revenue cycle management by ensuring codes accurately reflect services for claims acceptance through the claims adjudication and encounter reporting processes. The position also helps ensure full adherence to applicable contractual and regulatory requirements, particularly those related to services, codes, and associated minimum and maximum fee constraints. The Coding Analyst partners closely with Provider Relations by entering new codes and making modifications to existing codes in the EMR systems, ensuring alignment with provider contracts, covered services and reimbursement methodologies. This role creates accurate reporting of adequacy and other contract-required metrics and serves as a subject matter resource across departments, including researching claim denials, identifying root causes related to coding, and collaborating with appropriate teams to resolve issues. The position supports understanding of provider enrollment and its impact on coding, billing, and reimbursement practices. Additionally, the position works with the Data Analytics team to define, store, and analyze data needed to generate meaningful reports and support desired operational outcomes. Leads and supports ad hoc initiatives and priority projects as directed.

Requirements

Proficiency in medical coding systems including CPT and HCPCS
Minimum of three (3) years of experience with healthcare coding, preferably within Medicaid or managed care environments.
Competent in using Microsoft software including Excel; experience with data tools (SQL) and healthcare systems (EMR/HER platforms) knowledge desired.
Strong analytical and critical thinking skills, with the ability to research, interpret, and resolve misalignments related to coding.
Strong communication skills, with the ability to effectively convey technical issues to non technical internal stakeholders.
Ability to function effectively in a fast-paced, evolving and team-oriented environment with multiple priorities and objectives required.
Current driver’s license, acceptable driving record, and proof of adequate insurance required.

Nice To Haves

Certification from AAPC or equivalent (e.g., CPC, CRC, CCS, or CCS-P) or AHIMA is preferred.
Associate or bachelor’s degree in health information management, Healthcare Management, Statistics, or related field is preferred.
Experience with state Medicaid programs, managed care organizations or long-term care services a plus.
Knowledge or experience with managed care and insurance industry operations and functions preferred; experience across healthcare delivery models preferred.

Responsibilities

Manage and monitor coding data across all services, ensuring consistency and completeness.
Monitor changes in healthcare coding requirements and reimbursement methodologies and take responsibility for communicating updates and impacts to internal stakeholders.
Assure adherence to regulatory and contractual requirements.
Study and develop deep expertise in healthcare coding systems and their application across service delivery models.
Triage and analyze root causes for claim denials related to coding.
Participate in utilization review and quality improvement initiatives, applying analytical skills to identify opportunities for improvement.
Work with data source providers and technology teams to ensure that key decision data is accurate, relevant, complete, timely, and consistent.
Stay informed on changes from regulatory agencies, payers and industry standards to maintain accurate, compliant coding practices.
Function as a liaison between external stakeholders and internal departments, adapting communication styles to meet stakeholder needs.
Demonstrate awareness of departmental priorities and communicate coding-related changes in ways that support understanding and adoption across teams.
Partner closely with Provider Relations to ensure codes align with regulatory expectations and reimbursement structures and support successful claims and reporting outcomes.
Collaborate with internal stakeholders to clarify requirements, resolve coding issues, and ensure operational compliance.
Contribute to organizational quality initiatives and contract performance by ensuring coding practices are fully aligned with regulatory and payer requirements.
Help maintain operational integrity by supporting data accuracy, reporting needs, and contractually required outcomes.