Coder Analyst

Avera Health; South Dakota; On-site; USD 58,000 - 87,000; Full time

Benefits offered by this job

PTO from day 1

5% retirement match

Career development mentorship

Job summary

Avera Health seeks a qualified Medical Coding Specialist to coordinate National Coverage and Local Coverage Determination policies, as well as payer-specific Medicare materials. You will drive policy validation, education, and streamlined workflows across departments to ensure medical necessity compliance.

The role focuses on LCD/NCD policy processing, staff training, and collaboration with coders, managers, and vendors to resolve software inconsistencies and maintain accurate coding for claims.

Qualifications

• CCA, CCS-P, CCS, RHIA and RHIT certifications must be obtained within 180 days.
• 1–3 years of coding experience preferred.

Responsibilities

• Establish goals for processing LCD/NCD policies and communicate to departments.
• Support coders/managers with software inconsistencies for LCD/NCD policies.
• Provide presentations to staff on LCDs/NCDs.
• Collaborate and coordinate activities related to Medicare LCDs and NCDs.
• Review Medical Necessity ABN processes and related forms for compliance.
• Liaise for employee training on front‑end medical necessity tools.
• Reconcile edits in eProvider Solutions for correct claim processing.
• Coordinate with CDM team on code assignment trends.
• Improve processes for more accurate coding and claim submission.
• Stay updated on billing/coding edits and payer references.

Education

Certified Coding Associate (CCA)

Certified Coding Specialist - Physician-based (CCS-P)

Certified Coding Specialist (CCS)

Registered Health Information Administrator (RHIA)

Registered Health Information Technician (RHIT)

Job description

Location: Avera Health Worker Type: Regular Work Shift: Day Shift (United States of America) Pay Range: The pay range for this position is listed below. Actual pay rate dependent upon experience. $28.00 - $41.75

Position Highlights

You Belong at Avera Be part of a multidisciplinary team built with compassion and the goal of Moving Health Forward for you and our patients. Work where you matter.

A Brief Overview

Accountable to coordinate National Coverage and Determination (NCD) policies, Local Coverage Determination (LCD) policies, coverage policies for various payers and Medicare articles and any other activities related to medical necessity throughout Avera. Coordination of medical necessity activities includes: implementation of policy validation processes, education to departments on medical necessity guidelines, running reports for coverage review of new or existing policies, supporting appeals process, streamlining workflow for medical necessity, serving on committees, and other duties as necessary.

What you will do

• Establish goals for processing, researching and problem solving new, modified and deleted LCD and NCD policies as well as communicating essential information to appropriate departments and staff.
• Support coders/managers with software application inconsistencies for LCD/NCD policies by communicating with vendors and hospital leaders as necessary.
• Provide presentations to staff as necessary for information pertaining to LCDs/NCDs.
• Responsible to collaborate and coordinate activities related to Medicare LCDs and NCDs.
• Review Medical Necessity ABN process and other Notices of Non-Coverage forms annually, and more often as necessary, to ensure most recent forms are supported and prices are aligned within parameters regulated by Medicare and other payers.
• Serve as liaison for employee training on front end medical necessity tools such as installations, on-going education, proper functionality, and creation of new pick lists as necessary.
• Reconcile, track and trend edits through eProvider Solutions (ePS) Medical Necessity edits for correct processing of claims on various patient types and eliminate inefficiencies when possible.
• Communicate with CDM team on any trends identified that require adjustments to code assignment in the chargemaster and provide updates as necessary to support compliance.
• Collaborate with coders/managers on front end medical necessity edits that could impact back end edits to work towards a more streamlined approach for process improvement for accurate coding and claim submission.
• Review and keep informed of billing and coding edits relevant to this position such as regulatory guidelines and keeping current with payer specific references such as the Medicare Administrative.

Essential Qualifications

The individual must be able to work the hours specified. To perform this job successfully, an individual must be able to perform each essential job function satisfactorily including having visual acuity adequate to perform position duties and the ability to communicate effectively with others, hear, understand and distinguish speech and other sounds. These requirements and those listed above are representative of the knowledge, skills, and abilities required to perform the essential job functions. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential job functions, as long as the accommodations do not cause undue hardship to the employer.

Required Education, License/Certification, or Work Experience

• Certified Coding Associate (CCA) - American Health Information Management Association (AHIMA) within 180 Days
• Certified Coding Specialist - Physician-based (CCS-P) - American Health Information Management Association (AHIMA) within 180 Days
• Certified Coding Specialist (CCS) - American Health Information Management Association (AHIMA) within 180 Days
• Registered Health Information Administrator (RHIA) - American Health Information Management Association (AHIMA) Ranked by preference. within 180 Days
• Registered Health Information Tech (RHIT) - American Health Information Management Association (AHIMA) within 180 Days

Preferred Education, License/Certification, or Work Experience

• Associate's in Health Information Technology
• Bachelor's in Health Information Administration
• 1-3 years of coding experience

Expectations and Standards

Commitment to the daily application of Avera's mission, vision, core values, and social principles to serve patients, their families, and our community. Promote Avera's values of compassion, hospitality, and stewardship. Uphold Avera's standards of Communication, Attitude, Responsiveness, and Engagement (CARE) with enthusiasm and sincerity. Maintain confidentiality. Work effectively in a team environment, coordinating work flow with other team members and ensuring a productive and efficient environment. Comply with safety principles, laws, regulations, and standards associated with, but not limited to, CMS, The Joint Commission, DHHS, and OSHA if applicable.

Benefits

You Need & Then Some

Avera is proud to offer a wide range of benefits to qualifying part-time and full-time employees. We support you with opportunities to help live balanced, healthy lives. Benefits are designed to meet needs of today and into the future.

• PTO available day 1 for eligible hires.
• Up to 5% employer matching contribution for retirement
• Career development guided by hands-on training and mentorship

Avera is an Equal Opportunity Employer - Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, Veteran Status, or other categories protected by law.

If you are an individual with a disability and would like to request an accommodation for help with your online application, please call 1-605-504-4444 or send an email to [e-mail].

At Avera, the way you are treated as an employee translates into the compassionate care you deliver to patients and team members. Because we consider health care a ministry, you can live out your faith, uphold the dignity and respect of all persons while not compromising high-quality services. Join us in making a positive impact on moving health forward.