Senior Claims Coding Specialist: Adjudication & Governance

HealthPartners; BLOOMINGTON (MN); On-site; USD 90,000 - 120,000; Full time

Job summary

HealthPartners in Bloomington, MN seeks a Senior Claims Coding Analyst to provide expert coding compliance, adjudication accuracy, and system governance across CPT, HCPCS, ICD-10, and related code sets. You will lead coding system updates, vendor integrations, and coding policy initiatives to optimize revenue and compliance.

The role requires five years of multi-visit coding experience, HMO/government program exposure, and strong analytical abilities.

Qualifications

• Expert-level completion of Medical Coding Program with CPC/CCA/CCS certification.
• Minimum 5 years of coding experience across multiple patient visit types.
• Minimum 5 years experience with HMO, fully insured, indemnity, and government programs.
• Prior experience in medical claims processing and adjudication.
• Experience using coding software platforms and encoder tools.
• Ability to independently analyze and adjudicate complex claims.

Responsibilities

• Advanced Coding Compliance & Claims Adjudication: Review complex claims for coding accuracy and reimbursement integrity; approve/deny claims per guidelines; ensure HIPAA and coding standards compliance.
• Coding System Governance & Optimization: Administer coding systems and vendor editing software; support code set updates; lead testing and deployment.
• Analysis, Trend Identification & Revenue Optimization: Perform trend analysis on billing patterns; evaluate edits and business rules; support data-driven decisions.
• Stakeholder Leadership & Cross-functional Support: Act as SME for coding; participate in committees; guide policy development; communicate outcomes to stakeholders.
• Vendor & System Integration Management: Serve as primary contact for coding software vendors; collaborate with IT for system enhancements.
• Training, Mentorship & Documentation: Provide training; maintain documentation of policies and changes; ensure audit readiness.

Skills

Medical coding

Claims adjudication

Data analysis

Independent judgment

Communication skills

Education

Certification: CPC/CCA/CCS

Tools

Coding software platforms

Encoder tools

Job description

HealthPartners in Bloomington, MN seeks a Senior Claims Coding Analyst to provide expert coding compliance, adjudication accuracy, and system governance across CPT, HCPCS, ICD-10, and related code sets. You will lead coding system updates, vendor integrations, and coding policy initiatives to optimize revenue and compliance.

The role requires five years of multi-visit coding experience, HMO/government program exposure, and strong analytical abilities.