Coding Analyst

Unified Women's Healthcare•UNAVAILABLE, Florida

About The Position

The Coding Analyst reviews, audits, and codes provider documentation using ICD-10 and CPT codes to support reimbursement, training, education, and compliance. The role serves as an information resource for providers, clinical staff, practice managers, Revenue Cycle team members, and other leaders. The position analyzes pre-bill claim edits, denials, and accounts receivable management, and works with Revenue Specialists to review and amend denied claims for accurate coding and adherence to payer policies. The Coding Analyst also assists the Revenue Cycle Manager with proactive medical-record audits for compliance with federal coding regulations and guidelines. Using knowledge of client systems and procedures, the role provides second-level review of diagnosis and procedure codes and helps ensure medical billing meets legal, procedural, and compliance requirements. The analyst reviews and updates client procedures, systems, and protocols to maintain compatibility with billing requirements and compliance standards. The role also provides education and training to providers and staff, supports claims follow-up and reimbursement efforts, and maintains strict confidentiality of financial and medical records.

Requirements

Certified Professional Coder (CPC) certification.
At least 5 years of experience as a biller, collector, coder, back-office support staff member, or equivalent medical-industry experience.
Knowledge of auditing concepts and principles.
Advanced knowledge of medical coding and billing systems and regulatory requirements.
Ability to use independent judgment and manage and impart confidential information.
Ability to analyze and solve problems.
Strong communication and interpersonal skills.
Knowledge of legal, regulatory, and policy compliance issues related to medical coding, billing procedures, and documentation.
Knowledge of current and developing issues and trends in medical coding procedure requirements.

Nice To Haves

OB/GYN experience.
Associate degree from an accredited university.

Responsibilities

Provide second-level review of billing performance to ensure compliance with legal and procedural policies, optimize reimbursement, and avoid unbundling or other questionable practices.
Audit medical-record documentation for under-coded and over-coded services, prepare findings reports, and educate providers on accurate coding and compliance.
Communicate with physicians and other patient-care providers about billing and documentation policies, procedures, and regulations; query providers to clarify conflicting, ambiguous, or nonspecific documentation.
Report documentation issues and trends to the Revenue Cycle Manager and/or practice administrator.
Work with Revenue Specialists and practice billing specialists to ensure complete patient-account follow-up and maximize reimbursement through accounts receivable processes, including corrections and resubmissions.
Analyze payer performance related to fee-schedule reimbursements and trends.
Research, analyze, and respond to inquiries about compliance, payer policies and guidelines, inappropriate coding, denials, and billable services.
Monitor and distribute payer policy communications and updates relevant to provider specialties.
Provide training, guidance, and oversight to staff with less experience in coding guidelines.
Serve as a resource and subject matter expert for clinicians, and promote appropriate coding practices.
Train and support medical providers and practice billing specialists on coding compliance, documentation, regulatory provisions, and third-party payer requirements.
Review, develop, modify, and adapt client procedures, protocols, and data-management systems to ensure compliance with organizational policies.
Work with providers and management to review or implement codes and update charge documents.
Maintain knowledge of the healthcare revenue cycle, coding, claims, and state insurance laws.
Ensure strict confidentiality of financial and medical records.
Perform miscellaneous job-related duties as assigned.

Benefits

Medical, dental, and vision plans, fertility benefits, and supplemental insurance options.
Vacation, personal days, and paid holidays.
401(k) with employer contribution.
Flexible Spending Accounts (FSAs) and Health Savings Accounts (HSAs).
Short- and long-term disability coverage.
Paid parental leave.
Basic life insurance and optional additional coverage.
Employee Assistance Program.
Commuter benefits.
Pet insurance.
Identity theft protection.
Professional development opportunities and resources.