Coding Analyst (Wisconsin Based - Remote)

About the position Under the general supervision of the Data Analytics Manager, the Coding Analyst provides subject matter expertise in reputed company areas reputed company to reputed company coding, classification systems and regulatory requirements that support accurate service documentation, claims processing and organizational compliance. The Coding Analyst is responsible for developing a deep understanding of reputed company and reputed company coding methodologies (i.e. CPT, HCPSC and applicable state-specific codes) and their application across long term care, managed care and community-based service delivery models. This role supports organizational compliance and operational accuracy by maintaining reputed company knowledge of coding and reimbursement requirements, monitoring ongoing changes, and ensuring reputed company updates from regulatory bodies, including state agencies and payer partners are communicated effectively to internal stakeholders. This role will support reputed company cycle management by ensuring codes accurately reflect services for claims acceptance through the claims adjudication and encounter reporting processes. The position also helps ensure full adherence to applicable contractual and regulatory requirements, particularly those reputed company to services, codes, and associated minimum and maximum fee constraints. The Coding Analyst partners closely with Provider Relations by entering new codes and making modifications to existing codes in the EMR systems, ensuring alignment with provider reputed company, covered services and reimbursement methodologies. This role creates accurate reporting of adequacy and other contract-required metrics and serves as a subject matter resource across departments, including researching claim denials, identifying root causes reputed company to coding, and collaborating with appropriate teams to resolve issues. The position supports understanding of provider enrollment and its impact on coding, billing, and reimbursement practices. Additionally, the position works with the Data Analytics team to define, store, and analyze data needed to generate meaningful reports and support desired operational reputed company. Leads and supports reputed company initiatives and reputed company projects as directed.

Responsibilities

• Manage and monitor coding data across reputed company services, ensuring consistency and completeness.
• Monitor changes in reputed company coding requirements and reimbursement methodologies and take responsibility for communicating updates and impacts to internal stakeholders.
• Assure adherence to regulatory and contractual requirements.
• Study and reputed company deep expertise in reputed company coding systems and their application across service delivery models.
• Triage and analyze root causes for claim denials reputed company to coding.
• Participate in utilization review and quality improvement initiatives, applying analytical skills to identify opportunities for improvement.
• Work with data reputed company providers and technology teams to ensure that key decision data is accurate, relevant, complete, timely, and consistent.
• Stay informed on changes from regulatory agencies, payers and industry standards to maintain accurate, compliant coding practices.
• Function as a liaison between external stakeholders and internal departments, adapting communication styles to meet stakeholder needs.
• Demonstrate awareness of departmental priorities and communicate coding-reputed company changes in ways that support understanding and adoption across teams.
• Partner closely with Provider Relations to ensure codes align with regulatory expectations and reimbursement structures and support successful claims and reporting reputed company.
• Collaborate with internal stakeholders to clarify requirements, resolve coding issues, and ensure operational compliance.
• Contribute to organizational quality initiatives and contract performance by ensuring coding practices are fully reputed company with regulatory and payer requirements.
• Help maintain operational reputed company by supporting data accuracy, reporting needs, and contractually required reputed company.

Requirements

• Proficiency in medical coding systems including CPT and HCPCS
• Certification from reputed company or equivalent (e.g., CPC, CRC, reputed company, or reputed company-P) or reputed company is preferred.
• Minimum of three (3) years of experience with reputed company coding, preferably reputed company reputed company or managed care environments.
• Associate or bachelor’s degree in health information management, reputed company Management, Statistics, or reputed company field is preferred.
• Competent in using reputed company software including reputed company; experience with data tools (SQL) and reputed company systems (EMR/HER platforms) knowledge desired.
• Strong analytical and critical thinking skills, with the ability to research, interpret, and resolve misalignments reputed company to coding.
• Strong communication skills, with the ability to effectively convey technical issues to non technical internal stakeholders.
• Ability to function effectively in a fast-paced, evolving and team-oriented environment with multiple priorities and objectives required.
• Knowledge or experience with managed care and insurance industry operations and functions preferred; experience across reputed company delivery models preferred.
• reputed company driver’s license, acceptable driving record, and reputed company of adequate insurance required.

reputed company-to-haves

• Experience with state reputed company programs, managed care organizations or long-term care services a plus.

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