Claims Coding Analyst Senior

Senior Claims Coding AnalystHealthPartners is hiring a Senior Claims Coding Analyst. The Senior Coding Analyst provides advanced expertise in coding compliance, claims adjudication accuracy, and coding system governance. This role ensures the claims processing system accurately reflects industry-standard coding requirements including CPT, HCPCS, ICD-9, ICD-10, and related code sets to maintain regulatory compliance.

The Senior Analyst supports evaluation of new codes, regulatory updates, and plan-specific policies, while investigating complex claims to determine reimbursement accuracy and identify provider billing trends and errors. This position also leads coding system enhancements, supports integration of vendor editing solutions, and drives revenue optimization through coding accuracy and system configuration.MINIMUM QUALIFICATIONS:Expert-level completion of Medical Coding Program with certification (AAPC or AHIMA equivalent: CPC, CCA, CCS)Minimum 5 years of coding experience across multiple patient visit typesMinimum 5 years experience working with HMO, fully insured, indemnity, and government programsPrior experience in medical claims processing and adjudicationExperience using coding software platforms and system editing toolsDemonstrated ability to independently analyze and adjudicate complex claims scenariosLicensure/ Registration/ Certification:CPC, CCA, CCS or equivalent (required)Knowledge, Skills, and Abilities:Advanced knowledge of CPT, HCPCS, ICD-10, revenue codes, and claim formats (837P/837I)Strong understanding of anatomy, physiology, disease processes, and medical billing practicesKnowledge of COB rules including Medicare regulationsExperience with vendor coding software, claims processing systems, and encoder toolsStrong analytical, trend analysis, and problem-solving capabilitiesAbility to make independent decisions and complex judgment callsStrong organizational, planning, and prioritization skillsProficient in Microsoft tools and data analysisEffective communication skills across technical and business stakeholdersPREFERRED QUALIFICATIONS:Education, Experience or Equivalent Combination:Bachelor's degree in a related field7+ years of experience in the healthcare industryLicensure/ Registration/ Certification:Advanced or specialty coding certifications preferredKnowledge, Skills, and Abilities:Deep familiarity with coding governance, audit processes, and reimbursement methodologiesExperience supporting policy development and coding compliance initiativesESSENTIAL DUTIES:(25%) Advanced Coding Compliance & Claims AdjudicationReview complex claims for coding accuracy, medical appropriateness, and reimbursement integrityApprove or deny claims based on coding guidelines and policy requirementsResolve claim processing errors related to code validation during adjudicationEnsure compliance with HIPAA and industry coding standards across all claim types(20%) Coding System Governance & OptimizationAdminister, maintain, and audit coding systems and vendor editing softwareSupport implementation of new, revised, and deleted code sets including CPT pairsLead testing, validation, and deployment of coding system updatesEnsure system configurations align with regulatory, business requirements, and current coding requirements(20%) Analysis, Trend Identification & Revenue OptimizationPerform trend analysis to identify billing patterns, reimbursement impacts, and revenue opportunitiesEvaluate coding edits and business rules to ensure optimal system performanceIdentify opportunities to reduce claim inventory and improve financial outcomesSupport data-driven decision making through analytics and reporting(15%) Stakeholder Leadership & Cross-functional SupportServe as subject matter expert for coding across Claims, Sales, Contracting, and other departmentsRepresent the organization in internal committees and external industry forumsSupport policy development with Medical Policy, Government Programs, and compliance teamsCommunicate coding outcomes and provide guidance on complex issues(10%) Vendor & System Integration ManagementServe as primary contact for coding software vendorsCollaborate with Business Systems Analysts and IT to design and implement system enhancementsSupport integration and optimization of coding software within claims platforms(10%) Training, Mentorship & DocumentationProvide training, mentorship, and work direction to team membersMaintain accurate documentation of coding policies, procedures, and system changesEnsure audit readiness through comprehensive recordkeeping of coding updates