Remote Senior Clinical Coding Analyst — DoD-Eligible

TriWest Healthcare Alliance; Phoenix (AZ); On-site; USD 63,000 - 74,000; Full time

Benefits offered by this job

Medical, Dental and Vision Coverage

Paid time off

401(k) Retirement Savings Plan (with 


Short-term and long-term disability, 


Tuition reimbursement

Paid volunteer time

Job summary

TriWest Healthcare Alliance is seeking a Clinical Coding expert to conduct retrospective medical claims review for inpatient and outpatient services. This role supports medical directors, providers and claims teams, ensuring accurate DRG assignment and coding determinations.

Remote work is available with a Department of Defense background check requirement. The position requires CIC/CCS/RHIT certification, US citizenship, and 5+ years of coding experience, plus 3+ years in claims processing in a

Qualifications

• High School Diploma or GED required.
• Current CIC/CCS/RHIT certification.
• U.S. Citizen required.
• Must be able to receive favorable DoD background investigation.
• Minimum 5 years of clinical coding experience for facility and/or professional accounts.
• Minimum 3 years of claims processing experience for inpatient and/or outpatient accounts.
• Documented experience in a fast-paced environment.
• Preferred: CEHRS certification.

Responsibilities

• Subject matter expert on ICD-10-CM, ICD-10-PCS, CPT and HCPCS coding of medical claims.
• Lead coding projects as directed by Clinical Operations management.
• Provide training and mentoring for Clinical Coders.
• Perform DRG validation of medical claims coding.
• Conduct focused outpatient/inpatient claims reviews and audits.
• Identify and report potential fraud or quality issues.
• Research TRICARE manuals and current coding guidelines to assist processing.
• Monitor timeliness of retrospective claims reviews and ensure timelines.
• Prepare determination notices and other written correspondence.
• Identify questionable review decisions and escalate to Medical Director.

Skills

CIC

CCS

RHIT

US citizenship

Medical coding

Claims processing

Education

High School Diploma or GED

CIC/CCS/RHIT certification

Tools

MS Word

MS Excel

Job description

TriWest Healthcare Alliance is seeking a Clinical Coding expert to conduct retrospective medical claims review for inpatient and outpatient services. This role supports medical directors, providers and claims teams, ensuring accurate DRG assignment and coding determinations.

Remote work is available with a Department of Defense background check requirement. The position requires CIC/CCS/RHIT certification, US citizenship, and 5+ years of coding experience, plus 3+ years in claims processing in a