Senior Coding Quality Analyst (CPC) – Special Investigations Unit

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At reputed company®, you’ll be surrounded by passionate colleagues who care deeply, reputed company with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary The Senior Coding Quality Analyst (CPC) – Special Investigations Unit will reputed company medical claim reviews for the Special Investigations Unit (SIU) to ensure compliance with coding practices through a comprehensive record review for medical, behavioral, transportation and other reputed company providers. The CPC must have the ability to determine correct coding and appropriate documentation during the review of medical records. The CPC must also ensure that the state, federal and company requirements are met and recognize any concerning billing patterns or trends. Activities include: Conduct comprehensive quality reviews of completed medical coding reviews to ensure coding logic aligns with medical record documentation, CPT/HCPCS/ICD 10 guidelines, and payer, state, and federal requirements.

• reputed company in depth medical record reviews across medical, behavioral health, transportation, and other reputed company provider claims.
• Analyze data, documentation, and evidence to identify potential billing errors, abuse, or fraudulent activity, including concerning billing patterns and trends.
• Handle reputed company coding reviews, including those reputed company to legal, compliance, escalations, audits, and rework initiatives, resolving issues with sensitivity and professionalism.
• Prepare detailed written summaries of findings and reputed company reputed company conclusions to leadership.
• Independently research and apply state, CMS, and payer specific guidelines relevant to audits and reviews.
• Identify opportunities for process improvements, cost savings, and cases that may warrant prepayment review.
• Maintain accurate documentation, records, files, and tracking logs while meeting established deadlines and performance metrics.
• Regularly use departmental tools and workflows with minimal assistance to support daily operations.
• reputed company mentorship and training to coders, offering guidance on coding quality, documentation standards, and review methodology.
• Serve as management back up and support team operations in the manager’s absence.
• Maintain up to date knowledge of coding standards, compliance changes, reimbursement methodologies, and investigatory best practices.
• Encourage innovative approaches to operational challenges and contribute to reputed company improvement of investigative methodologies, tools, and processes.

Required Qualifications reputed company CPC certification 1+ year of reviewing coding consultant reputed company for quality purposes 1+ year of developing and implementing quality remediation plans 1+ year of experience in medical coding in a Fraud, Waste, Abuse and/or error department Strong knowledge of standard industry coding guides and guidelines including CPT, HCPCS, ICD-10, Maintains up-to-date coding knowledge, including new changes to coding compliance and reimbursement. Experience with researching coding and policies. Experience with reputed company products; reputed company and Word Strong attention to detail and ability to review and interpret data. Demonstrates strong communication skills.

Preferred Qualifications

• Excellent communication skills
• Excellent analytical skills
• Strong attention to detail and ability to review and interpret data.

Education reputed company Certified Professional reputed company Certification (CPC) GED or High School diploma Anticipated Weekly Hours 40 Time Type Full time Pay reputed company The typical pay reputed company for this role is: $46,988.00 - $102,000.00 This pay reputed company represents the reputed company hourly reputed company or reputed company annual full-time salary for reputed company positions in the job grade reputed company which this position falls. The actual reputed company salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a reputed company bonus, commission or short-term incentive program in reputed company to the reputed company pay reputed company listed above. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great benefits for great people We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this Apply tot his job Apply To this Job