Coding Analyst

Medica•,

4d•$45,900 - $78,600•Remote

About The Position

The Coding Analyst II performs high‑level coding, audit, and analysis activities that ensure accurate application of medical coding standards within claims, reimbursement, and operational workflows. This role interprets clinical documentation, applies established coding guidelines, and identifies discrepancies that impact claims accuracy, provider reimbursement, or regulatory compliance. It works with minimal supervision on moderately complex cases, serves as a resource to peers, and contributes to coding quality improvement efforts. The Coding Analyst also supports cross‑functional partners by offering coding expertise that strengthens data integrity, payment accuracy, and operational consistency. As a Coding Analyst on Medica's Payment Integrity Team, you will serve as subject matter expert for coding-related inquiries from various internal departments and are responsible for providing accurate coding information (CPT, HCPCS, ICD-10, etc) for the implementation and maintenance of medical code sets within the systems and posted on Medica.com.

Requirements

Bachelor's degree or equivalent experience in related field
3+ years of medical coding experience within a Health Plan or Payment Integrity department
Current professional coding certification from a nationally recognized credentialing organization such as the American Academy of Professional Coders (AAPC) or the American Health Information Management Association (AHIMA).
Acceptable certifications may include, but are not limited to, CPC, CPC-H (COC), CCS, CCS-P, RHIT, or RHIA. Certification must be maintained in good standing throughout employment.
Eligibility to work in the US: Medica does not offer work visa sponsorship for this role. All candidates must be legally authorized to work in the United States at the time of application. Employment is contingent on verification of identity and eligibility to work in the United States.

Nice To Haves

Certified Professional Coder (CPC) and Certified Outpatient Coder (COC) coding certifications are highly preferred.
Experience supporting coding-related system configuration, business rules, or claims processing logic.
Experience serving as a subject matter expert for cross-functional stakeholders, including claims operations, appeals, medical management, and clinical teams.
Familiarity with coding and reimbursement platforms such as Optum EncoderPro, Optum CES, HealthRules, or similar healthcare technologies.
Intermediate Microsoft Excel skills, including data analysis, sorting, filtering, comparisons, pivot tables, and formulas.
Abiliyt to work successfully in a remote work environment with minimal supervision.

Responsibilities

Review and code clinical documentation using ICD, CPT, HCPCS, and internal coding guidelines.
Validate coding accuracy to support compliant billing, reimbursement, and data reporting.
Research missing or unclear information to ensure proper code assignment.
Complete timely coding reviews that enable accurate claims processing.
Perform audits of claims, encounters, and documentation to detect coding errors or inconsistencies.
Analyze coding patterns to identify trends, risks, or gaps affecting payment accuracy.
Document findings clearly and recommend corrective actions that reduce recurrence.
Communicate audit results to internal partners, ensuring clarity, professionalism, and follow‑through.
Investigate coding impacts on claims adjudication, reimbursement, and provider disputes.
Collaborate with configuration, operations, and provider teams to resolve issues efficiently.
Verify coding rules within system logic and flag discrepancies for correction.
Support issue triage workflows that improve operational stability and payment accuracy.
Apply coding regulations, payer guidelines, and organizational policies consistently.
Maintain compliance with regulatory requirements, audit standards, and documentation expectations.
Participate in coding quality initiatives that strengthen accuracy and reduce rework.
Monitor updates to coding rules and support implementation of required changes.
Provide guidance to junior analysts on coding practices, documentation requirements, and audit methods.
Assist with training, documentation updates, and knowledge‑sharing within the team.
Participate in process improvement efforts that enhance coding workflows and accuracy.
Contribute to team goals by delivering reliable expertise, consistent quality, and timely work.
Other duties as assigned.