Senior Medical Claims Coding Strategist

Socket.dev; BLOOMINGTON (MN); On-site; USD 90,000 - 130,000; Full time

Job summary

HealthPartners is seeking a Senior Claims Coding Analyst to provide expert coding compliance and adjudication accuracy. You will drive coding governance, evaluate new codes, and oversee vendor editing solutions to optimize revenue and ensure regulatory compliance across CPT, HCPCS, ICD-9/10, and related code sets.

Role requires leadership in coding system enhancements, strong analytical abilities, and cross-functional collaboration with Medical Policy, Government Programs, and IT teams.

Qualifications

• Advanced knowledge of CPT, HCPCS, ICD-10, revenue codes, and claim formats (837P/837I).
• Strong understanding of anatomy, physiology, disease processes, and medical billing practices.
• Knowledge of COB rules including Medicare regulations.
• Experience with vendor coding software, claims processing systems, and encoder tools.
• Strong analytical, trend analysis, and problem-solving capabilities.

Responsibilities

• Review complex claims for coding accuracy, medical appropriateness, and reimbursement integrity.
• Approve or deny claims based on coding guidelines and policy requirements.
• Resolve claim processing errors related to code validation during adjudication.
• Ensure compliance with HIPAA and industry coding standards across all claim types.
• Administer, maintain, and audit coding systems and vendor editing software.
• Lead testing, validation, and deployment of coding system updates.
• Perform trend analysis to identify billing patterns, reimbursement impacts, and revenue opportunities.
• Communicate coding outcomes and provide guidance on complex issues.
• Provide training, mentorship, and documentation of coding policies.

Skills

CPT/HCPCS/ICD-10

Coding governance

Analytical skills

HIPAA compliance

Microsoft Excel

Communication skills

Independent decision making

Education

Bachelor’s degree in related field

Advanced coding certifications preferred

Tools

Coding software platforms

Encoder tools

Vendor editing software

Job description

HealthPartners is seeking a Senior Claims Coding Analyst to provide expert coding compliance and adjudication accuracy. You will drive coding governance, evaluate new codes, and oversee vendor editing solutions to optimize revenue and ensure regulatory compliance across CPT, HCPCS, ICD-9/10, and related code sets.

Role requires leadership in coding system enhancements, strong analytical abilities, and cross-functional collaboration with Medical Policy, Government Programs, and IT teams.