What are the responsibilities and job description for the Claims Coding Analyst Senior position at HealthPartners?
Job Description
HealthPartners is hiring a Senior Coding Analyst provides business support in the proper use, code compliance and processing guidelines of insurance industry-standard coding, including CPT/HCPCS codes. The Senior Coding Analyst is responsible for ensuring the claims processing system accurately reflects active CPT-4, HCPCS, ICD-9, ICD-10 and other code sets to ensure HIPPA compliance. The Senior Coding Analyst will leverage system software and their industry and coding knowledge to support the evaluation of new codes, CMS or other state/government policy changes or plan specific policies. The Senior Coding Analyst investigates deficient claims to determine approval/denial status, payable reimbursement and to identify potential provider billing trends and errors. The Senior Coding Analyst ensures completion of necessary changes to the system as a result of edits to current code management procedures and facilitates necessary coding system configuration changes.
The Senior Coding Analyst administers, manages, supports and audits the vended code editing software and updates the claims processing system with new, revised and deleted CPT code pairs.
Accountabilities
Provides expertise to all areas of the organization relating to coding questions including communication of new/deleted codes and coding policy changes
Monitors CMS, NUBC, and other agencies for transaction code set updates
Participates on internal coding committees
Represents HealthPartners and its interests in external industry forums at both the national and local level.
Facilitates testing and implementation of required system coding software updates
Resolves claim processing errors related to code validation edits during adjudication
Provides expertise in the evaluation of coding and transaction based business rules
Performs coding review to recommend new codes or deletion from all claims policy documentation
Acts as a key point of contact for claims, sales and contracting, researches all requests triggered from coding denials/provider appeals or adjustment requests
Performs daily review of deficient claims to determine proper coding and medical appropriateness
Approves or denies claims independently
Serves as the primary contact with the external coding software vendor for ongoing maintenance and customization
Communicates results of coding review to members and providers when appropriate
Develops and ensures coding software documentation is current and complete for business operational procedures, users and providers
Keeps accurate records of all coding changes for internal and external auditors
Collaborates, provides business support and proposes solutions to QUI/Medical Policy/Government Programs on member coverage criteria, code compliance and policy development
Performs trend analysis to evaluate provider reimbursement impacts, minimize inventory and increase revenue.
Serves as business coding architect to ensure edits achieve required business objectives
Works with Business System Analysts and Information Services Developers to research, evaluate, test and administer claims system enhancements and revenue generating code editing
Participates in the analysis, technical design, testing and integration of vended code editing software with HealthPartners’ core claim processing system
Leadership responsibility to influence, train, mentor and provide work direction to team members as directed
Required Qualifications
Expert level proficiency and completion of Medical Coding Program and Certification (AAPC or equivalent) required, CPC, CCA, CCS
ICD-10 Certified
Demonstrated use of medical terminology, anatomy, physiology and disease processes as related to CPT4, HCPCS, Rev Codes, ICD9, ICD-10, 837P (HCFA 1500), 837I (UB – 1450) coding terms, methodologies and forms
5 years coding experience related to all types of patient visits
5 years’ experience with HMO, fully insured and Indemnity products as well as government programs
Prior experience processing medical claims
Confident understanding COB (coordination of benefits) rules including Medicare regulations, policies and procedures
Computer literate and proficient using MicroSoft products and Encoder
5 years’ experience using vended coding software products
Solid understanding of standard claims processing systems and data analysis
Excellent planning and organizational skills
Demonstrated depth of knowledge and experience in medical claims procedures, processes, governing rules and all aspects of claim adjudication
Ability to work and make logical decisions independently
Demonstrated analytical skills when performing trend analysis
Understanding of provider medical billing practices
Comfortable making difficult judgement calls
Preferred Qualifications
Bachelor’s Degree in relevant field
7 years’ experience in the health care industry
About Us
At HealthPartners we believe in the power of good – good deeds and good people working together. As part of our team, you’ll find an inclusive environment that encourages new ways of thinking, celebrates differences, and recognizes hard work.
We’re a nonprofit, integrated health care organization, providing health insurance in six states and high-quality care at more than 90 locations, including hospitals and clinics in Minnesota and Wisconsin. We bring together research and education through HealthPartners Institute, training medical professionals across the region and conducting innovative research that improve lives around the world.
At HealthPartners, everyone is welcome, included and valued. We’re working together to increase diversity and inclusion in our workplace, advance health equity in care and coverage, and partner with the community as advocates for change.
Benefits Designed To Support Your Total Health
As a HealthPartners colleague, we’re committed to nurturing your diverse talents, valuing your dedication, and supporting your work-life balance. We offer a comprehensive range of benefits to support every aspect of your life, including health, time off, retirement planning, and continuous learning opportunities. Our goal is to help you thrive physically, mentally, emotionally, and financially, so you can continue delivering exceptional care.
Join us in our mission to improve the health and well-being of our patients, members, and communities.
We are an Equal Opportunity Employer and do not discriminate against any employee or applicant because of race, color, sex, age, national origin, religion, sexual orientation, gender identify, status as a veteran and basis of disability or any other federal, state or local protected class.
HealthPartners is hiring a Senior Coding Analyst provides business support in the proper use, code compliance and processing guidelines of insurance industry-standard coding, including CPT/HCPCS codes. The Senior Coding Analyst is responsible for ensuring the claims processing system accurately reflects active CPT-4, HCPCS, ICD-9, ICD-10 and other code sets to ensure HIPPA compliance. The Senior Coding Analyst will leverage system software and their industry and coding knowledge to support the evaluation of new codes, CMS or other state/government policy changes or plan specific policies. The Senior Coding Analyst investigates deficient claims to determine approval/denial status, payable reimbursement and to identify potential provider billing trends and errors. The Senior Coding Analyst ensures completion of necessary changes to the system as a result of edits to current code management procedures and facilitates necessary coding system configuration changes.
The Senior Coding Analyst administers, manages, supports and audits the vended code editing software and updates the claims processing system with new, revised and deleted CPT code pairs.
Accountabilities
Provides expertise to all areas of the organization relating to coding questions including communication of new/deleted codes and coding policy changes
Monitors CMS, NUBC, and other agencies for transaction code set updates
Participates on internal coding committees
Represents HealthPartners and its interests in external industry forums at both the national and local level.
Facilitates testing and implementation of required system coding software updates
Resolves claim processing errors related to code validation edits during adjudication
Provides expertise in the evaluation of coding and transaction based business rules
Performs coding review to recommend new codes or deletion from all claims policy documentation
Acts as a key point of contact for claims, sales and contracting, researches all requests triggered from coding denials/provider appeals or adjustment requests
Performs daily review of deficient claims to determine proper coding and medical appropriateness
Approves or denies claims independently
Serves as the primary contact with the external coding software vendor for ongoing maintenance and customization
Communicates results of coding review to members and providers when appropriate
Develops and ensures coding software documentation is current and complete for business operational procedures, users and providers
Keeps accurate records of all coding changes for internal and external auditors
Collaborates, provides business support and proposes solutions to QUI/Medical Policy/Government Programs on member coverage criteria, code compliance and policy development
Performs trend analysis to evaluate provider reimbursement impacts, minimize inventory and increase revenue.
Serves as business coding architect to ensure edits achieve required business objectives
Works with Business System Analysts and Information Services Developers to research, evaluate, test and administer claims system enhancements and revenue generating code editing
Participates in the analysis, technical design, testing and integration of vended code editing software with HealthPartners’ core claim processing system
Leadership responsibility to influence, train, mentor and provide work direction to team members as directed
Required Qualifications
Expert level proficiency and completion of Medical Coding Program and Certification (AAPC or equivalent) required, CPC, CCA, CCS
ICD-10 Certified
Demonstrated use of medical terminology, anatomy, physiology and disease processes as related to CPT4, HCPCS, Rev Codes, ICD9, ICD-10, 837P (HCFA 1500), 837I (UB – 1450) coding terms, methodologies and forms
5 years coding experience related to all types of patient visits
5 years’ experience with HMO, fully insured and Indemnity products as well as government programs
Prior experience processing medical claims
Confident understanding COB (coordination of benefits) rules including Medicare regulations, policies and procedures
Computer literate and proficient using MicroSoft products and Encoder
5 years’ experience using vended coding software products
Solid understanding of standard claims processing systems and data analysis
Excellent planning and organizational skills
Demonstrated depth of knowledge and experience in medical claims procedures, processes, governing rules and all aspects of claim adjudication
Ability to work and make logical decisions independently
Demonstrated analytical skills when performing trend analysis
Understanding of provider medical billing practices
Comfortable making difficult judgement calls
Preferred Qualifications
Bachelor’s Degree in relevant field
7 years’ experience in the health care industry
About Us
At HealthPartners we believe in the power of good – good deeds and good people working together. As part of our team, you’ll find an inclusive environment that encourages new ways of thinking, celebrates differences, and recognizes hard work.
We’re a nonprofit, integrated health care organization, providing health insurance in six states and high-quality care at more than 90 locations, including hospitals and clinics in Minnesota and Wisconsin. We bring together research and education through HealthPartners Institute, training medical professionals across the region and conducting innovative research that improve lives around the world.
At HealthPartners, everyone is welcome, included and valued. We’re working together to increase diversity and inclusion in our workplace, advance health equity in care and coverage, and partner with the community as advocates for change.
Benefits Designed To Support Your Total Health
As a HealthPartners colleague, we’re committed to nurturing your diverse talents, valuing your dedication, and supporting your work-life balance. We offer a comprehensive range of benefits to support every aspect of your life, including health, time off, retirement planning, and continuous learning opportunities. Our goal is to help you thrive physically, mentally, emotionally, and financially, so you can continue delivering exceptional care.
Join us in our mission to improve the health and well-being of our patients, members, and communities.
We are an Equal Opportunity Employer and do not discriminate against any employee or applicant because of race, color, sex, age, national origin, religion, sexual orientation, gender identify, status as a veteran and basis of disability or any other federal, state or local protected class.
