Medical Coding Analyst

Role Summary:

We are looking for an experienced Medical Coding Analyst to join our Analytics team. In this role, you will be responsible for supporting our episode pricing and analytics operations. You will work closely with the Analytics team to price our episode-based benefit historical claims data under different network contracts, using both Transparency MRF Data and additional contract information. You will also be responsible for continuous monitoring of the accuracy of the analytical claims pricing relative to real claims records. We will expect you to advise on the quality and completeness of Transparency MRF data.

Responsibilities:

●      Provide medical coding expertise and guidance to the analytic and clinical teams involved in program design, pricing, and monitoring

●      Assist in pricing clams under different network contracts and fee schedules as part of the analytical pricing of Oxbridge products

●      Critically review Payer Transparency Data to identify potential deficiencies and errors

●      Compare analytical claims pricing with subsequent real-time production claims pricing

●      Ensure coding accuracy and compliance with coding guidelines, regulations, and payer-specific requirements

●      Assist in the analysis of claims data to detect anomalous billing patterns including duplication of services, missing services, and inaccurate claim elements

●      Assist in the analysis of coding-related data for performance improvement initiatives and program evaluation

●      Maintain a comprehensive understanding of the company’s clinical episodes of care definitions and their specific coding requirements

●      Stay up-to-date with changes in coding guidelines, regulations, and industry best practices

Qualifications:

●      Bachelor’s degree in health information management, health informatics, or another related field

●      Current certification as a Professional Coder (CPC) through AAPC or Certified Coding Specialist (CCS) through AHIMA

●      4+ years experience working as a medical coder or revenue cycle manager, preferably in a hospital setting

●      Experience with billing of products (implants, drugs, etc.) commonly carved out from facility payment rates

●      Subject matter expertise pertaining to the appropriate use of ICD10 diagnosis and procedure, CPT/Modifier, HCPCS, DRG, NDC, and other billing code sets 

●      Subject matter expertise pertaining to the accurate assignment of codes to claims and their effect on payment calculations

●      Ability to perform simple to moderately complex analyses using Microsoft Excel, willingness to develop additional data skills

●      Experience maintaining code lists, working with claims data, and data management tools

●      Ability to independently work through classifying and quantifying coding problems in claims data