Coding Analyst

Providence•Spokane, WA

About The Position

The Coding Analyst is responsible for detailed diagnostic coding related to Risk Adjustment and HCC coding. The work affects revenue and CMS compliance and involves coordinating technically detailed coding applications across operations, programs, information systems, Health Plans, contracted facilities, and providers. The analyst applies a comprehensive understanding of ICD-9, ICD-10, and other coding systems; identifies and researches provider diagnostic coding issues; reviews medical records and documentation standards; and identifies provider coding errors and offers related education. The role also advises on the development of Health Plan payment rules related to risk adjustment. The position involves maintaining credibility with providers regarding coding rules and applications, integrating coding applications as Health Plans change, managing multiple priorities and deadlines, coordinating workload throughout the year, and communicating effectively with Plan departments, personnel at all levels, providers, provider office staff, and hospital staff. The analyst must stay current with frequently changing coding rules, regulations, and accrediting-body requirements and determine how changes affect Health Plan operations. Providence describes its culture as patient-focused and centered on whole-person care, understanding, commitment, and mutual respect. The organization says it empowers caregivers and offers benefits intended to support employees and their families’ well-being, professional growth, and financial security.

Requirements

Completion of coursework or training in an accredited medical coding program, or coding experience in a healthcare setting may be considered.
Three years of experience as a certified coder within a healthcare provider organization or health insurance company.

Nice To Haves

Bachelor’s degree or equivalent education/experience.
One year of experience in HCC coding.

Responsibilities

Perform detailed diagnostic coding related to Risk Adjustment and HCC coding.
Coordinate technically detailed coding applications that affect operations, programs, information systems, contracted providers, revenue, and CMS compliance.
Identify and research provider diagnostic coding issues.
Review medical records and documentation standards.
Identify provider coding errors and offer related education.
Advise on the development of Health Plan payment rules related to risk adjustment.
Maintain credibility with providers regarding coding rules and applications.
Integrate coding applications into the changing Health Plan environment.
Manage multiple priorities and coordinate workloads to meet varying deadlines throughout the year.
Communicate effectively with Plan departments, personnel at all levels, providers, provider office staff, and hospital staff.
Stay current with changing coding rules, regulations, and accrediting-body requirements, and determine their impact on Health Plan operations.