CLINICAL CODING ANALYST

Health Business Solutions LLC; Cebu City; On-site; PHP 334,800 - 558,000; Full time

Job summary

A healthcare solutions firm is seeking a Clinical Coding Analyst to review and analyze denied claims, support coding appeals, and conduct audits to validate coding practices. The ideal candidate has a Bachelor's degree in Nursing or a related field, holds relevant certifications, and possesses at least 2-3 years of coding experience. Proficiency in coding software and effective communication skills are essential to collaborate with cross-functional teams. This role offers the opportunity to improve healthcare delivery through accurate coding practices.

Qualifications

• Minimum of 2-3 years of medical coding or auditing experience.
• Experience with risk adjustment audits and payer audits.
• Familiarity with medical necessity criteria and reimbursement methodologies.

Responsibilities

• Review and analyze claims that have been denied due to coding-related issues.
• Prepare and support coding-based appeals with clinical justifications.
• Conduct in-depth coding audits and validate coding practices.

Skills

Knowledge of ICD-10

Knowledge of CPT

Knowledge of HCPCS

Detail-oriented mindset

Effective communication skills

Education

Bachelor's degree in Nursing or related field

Certified Professional Coder (CPC)

Certified Coding Specialist (CCS)

Certified Inpatient Coder (CIC)

Tools

Coding software

Electronic Health Record (EHR) systems

Job description

CLINICAL CODING ANALYST

Key Responsibilities:

Review and analyze claims that have been denied due to coding-related issues, including diagnosis codes (ICD-10-CM), procedure codes (CPT/HCPCS), and related modifiers.

Identify coding discrepancies, documentation deficiencies, and other factors contributing to claims denials, utilizing a thorough understanding of coding guidelines, industry standards, and regulatory requirements.

Collaborate with coding teams, healthcare providers, and revenue cycle stakeholders to obtain necessary documentation and information for claims resubmission.

Prepare and support coding‑based appeals by developing clear clinical and coding justifications.

Review medical records, payer policies, and coding guidelines to support appeal arguments.

Conduct in-depth coding audits and analysis to validate the accuracy, completeness, and compliance of coding practices, and ensure alignment with payer requirements.

Research and interpret coding guidelines, including updates from coding authorities, to ensure coding accuracy and compliance.

Maintain up-to-date knowledge of payer policies, medical necessity criteria, and reimbursement guidelines to accurately evaluate coding denials and appeals.

Compile and prepare detailed reports on coding-related denials, identifying patterns, trends, and opportunities for process improvement.

Collaborate with the revenue cycle team to develop strategies and initiatives aimed at reducing coding-related denials and improving overall revenue cycle performance.

Stay informed about emerging coding trends, changes in coding guidelines, and industry best practices, and provide recommendations for updating coding processes and policies.

Participate in coding-related meetings, committees, and training sessions to share insights, contribute to problem‑solving, and promote cross‑departmental collaboration.

Qualifications:

• Certifications: Certified Professional Coder (CPC), Certified Coding Specialist (CCS), Certified Inpatient Coder (CIC), or similar certification is required. Experience: Minimum of 2-3 years of medical coding or auditing experience and experience with risk adjustment audits, clinical documentation improvement (CDI), and payer audits.
• Knowledge of Coding Systems: Strong knowledge of ICD-10, CPT, and HCPCS coding systems, and familiarity with DRG, E/M coding.
• Bachelor's degree: in Nursing, or any Medical or Health Information Management or a related field.
• Familiarity with medical necessity criteria, payer policies, and reimbursement methodologies.
• Excellent understanding of revenue cycle processes, claims processing workflows, and denials management.
• Proficiency in using coding software, encoders, and electronic health record (EHR) systems.
• Detail‑oriented mindset with a high level of accuracy and organizational skills.
• Effective communication and interpersonal skills to collaborate with coding teams, providers, and other stakeholders.
• Ability to work independently, prioritize tasks, and meet deadlines in a fast‑paced environment.

Proficiency in using coding‑related software and tools, as well as a high level of computer literacy. Join our dynamic team as a Clinical Coding Analyst and contribute to the resolution of coding‑related denials, ensuring accurate and compliant coding practices that maximize reimbursement and support optimal healthcare delivery.