Coding Analyst at Change Healthcare

Change Healthcare

Coding Analyst

Remote – US

Overview of Position

The Payment Integrity Coding Analyst researches and interprets healthcare correct coding using regulatory requirements and guidance related to CMS, CPT/AMA and other major payer policies. They also use internal business rules to prepare written documentation of findings through medical record review. The Coding Analyst possesses an overall understanding of all coding principles, including facility, provider and DME type coding and provide health care payers with a total claim management solution. Typically, 90% of a Coding Analyst’s time is spent performing coding and documentation review and 10% spent performing other tasks as assigned.

What will be my duties and responsibilities in this job?

  • Conduct coding reviews of medical records and supporting documentation against submitted claims, for individual provider and facility claims, to determine coding and billing accurate for all products.
  • Process and/or review claims in a timely manner utilizing client specific coding and billing requirements that meet or exceed production and quality goals.
  • Participate in process improvement activities and encourage ownership of and group participation in improvement initiatives
  • Analyze medical documents to evaluate potential issues of fraud and abuse.
  • Document coding review findings within investigative case tracking system and maintains thorough and objective documentation of findings.
  • Serve as a coding resource and provide coding expertise and guidance to entire investigation and/or clinical team
  • Monitor, track, and report on all case work.
  • Communicate determinations verbally and/or in writing to appropriate business department as required by department internal workflow policies
  • Identify and recommend opportunities for cost savings and improving outcomes.
  • Coordinate activities with varying levels of leadership including the investigative team, legal counsel, internal and external customers, law enforcement and regulatory agencies, and medical professionals through effective verbal and written communications.
  • Research and interpret correct coding guidelines and internal business rules to respond to customer inquiries, and monitors CMS and major payer coding and reimbursement policies.

What are the requirements needed for this position?

  • AS degree or Equivalent in Health Information Management
  • 3+ years’ experience in medical coding with primary focus in facility and pro fee coding
  • Nationally recognized coding credential required: RHIA, RHIT, CCS-P, or CPC
  • Strong Microsoft Office skills including Outlook, Excel, and Word.
  • Proven ability to review, analyze, and research coding issues.
  • Reimbursement policy and/or claims experience

What other skills/experience would be helpful to have?

  • Excellent communication skills both verbal and written with a high attention to detail.
  • Proficiency in navigating various computer applications with the ability to ramp up quickly.
  • Ability to learn and navigate multiple computer programs quickly and effectively.
  • Ability to establish good customer relationships with trust and respect.
  • Good interpersonal skills.
  • Self-starting and independent, able to stay focused while working remotely.
  • Attention to detail is critical.

What are the working conditions and physical requirements of this job?

  • Must be available to work full-time, Monday-Friday (time to be determined).
  • Ability to work in front of a computer nearly 100% of each day.
  • Ability to work independently and communicate primarily through instant messaging (Skype, Jabber), email (Outlook) or the telephone.

How much should I expect to travel?

No travel for this role

Employees in roles that require travel will need to be able to qualify for a company credit card or be able to use their own personal credit card for travel expenses and submit for reimbursement.

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