Lead Code Edit Analyst

ECU Health Medical Center•Greenville, NC

7d•$30 - $44•Remote

About The Position

The Lead Code Edit Analyst provides operational leadership, technical expertise, and oversight to the Code Edit Analyst team to support consistent, compliant, and efficient claims processing. The role serves as a subject matter expert in medical necessity, Correct Coding Initiative (CCI) requirements, and reimbursement methodologies, and leads training, monitoring, performance tracking, and trend analysis. The position oversees accurate ICD-10, CPT, HCPCS, and modifier assignments; complex coding audits; identification of systemic coding and billing trends; and process improvements intended to enhance compliance, reduce denials, and optimize revenue integrity. It collaborates with Billing, Coding, Clinical Departments, Revenue Integrity, CDI, Compliance, and Revenue Cycle Leadership to align work with CMS guidelines, payer regulations, and organizational goals. This is a full-time, remote role based out of Greenville, North Carolina, with a Monday-through-Friday day shift. Training hours are 8:00 a.m. to 4:30 p.m. The listed pay range is $30.00–$43.73 per hour.

Requirements

Bachelor’s degree in a related discipline, or more than five years of extensive experience with an intermediate auditing background and a coding certificate as a substitute.
Required certification: Certified Coding Specialist (CCS), CPC, RHIT, or equivalent.
Comprehensive knowledge of CMS payment systems and reimbursement methodologies.
Experience with hospital information systems and claims platforms.
Ability to interpret and apply regulatory guidance from CMS and third-party payers.
Strong communication and presentation skills.
Knowledge of Privacy Act and HIPAA compliance requirements.
Proficiency in reimbursement methodologies, hospital and/or professional information systems, and coding methodologies.
Ability to analyze complex medical records and identify billable services.
Strong quantitative, analytical, and organizational skills.
Ability to use and understand computer technology.
Advanced knowledge of ICD-10, HCPCS, and CPT-4 coding schemes.
Advanced knowledge of UB-04/837 and 1500 claim form loops and segments.
Understanding of charging and coding processes and compliance guidelines.
Ability to research and interpret payer regulations and coding guidelines.
Knowledge of medical terminology, anatomy, and physiology.
Strong interpersonal and leadership capabilities.

Nice To Haves

Previous leadership, mentoring, or training experience is preferred.
Epic experience is preferred.

Responsibilities

Provide day-to-day oversight of Code Edit Analysts, ensuring productivity, quality, and adherence to workflows.
Monitor team performance using KPIs, quality audits, and productivity benchmarks.
Conduct one-on-one coaching sessions and team huddles to address performance trends and barriers.
Develop and deliver onboarding and ongoing training on coding updates, CMS transmittals, payer requirements, and system changes.
Perform secondary reviews and quality audits of team members’ work.
Identify knowledge gaps and create targeted education plans.
Serve as an escalation point for complex coding, billing, and compliance questions.
Perform advanced daily coding reviews of assigned claims to validate ICD-10, CPT, HCPCS, and modifier assignments.
Review UB-04/837 and 1500 claim data against medical record documentation for Medicare and commercial payer compliance.
Interpret and operationalize CMS memos, transmittals, and payer updates.
Ensure adherence to AHIMA and AAPC Standards of Ethical Coding.
Identify and report compliance risks and systemic billing vulnerabilities to leadership.
Monitor dashboards for denial trends related to pre-bill and post-bill edit performance.
Analyze professional and/or hospital claims trends and variations to identify root causes.
Assist with monthly and quarterly trend reports for Revenue Cycle Leadership.
Help quantify the financial impact of systemic billing and coding errors and present actionable recommendations.
Track the effectiveness of corrective actions and education initiatives.
Collaborate with Chargemaster, CDI, Billing, and Clinical Departments to resolve systemic issues.
Assist in developing standardized workflows to improve pre-bill review processes and reduce downstream denials.
Support contract compliance reviews and new product or service implementation.
Work with Billing Supervisors, Managers, and Directors to facilitate mandated coding and compliance changes.
Participate in Revenue Cycle performance improvement committees and initiatives when applicable.
Provide education to revenue-producing department staff as requested by department supervisors, managers, or directors.
Meet productivity and accuracy standards defined by the Billing Manager or Revenue Cycle Leadership Team.