Sr. Claims Coding Analyst

Healthfirst; United States; Remote; USD 71,000 - 107,000; Full time

Job summary

An established industry player is seeking a Sr Claims Coding Analyst to enhance claims editing systems and ensure proper claims payments. This role involves independent judgment in complex coding decisions, collaborating with various teams, and providing guidance to junior analysts. The ideal candidate will have a coding certification, experience in medical coding, and a strong understanding of insurance policies and coding guidelines. Join a dynamic team where your expertise will contribute to improving healthcare outcomes and ensuring compliance with industry standards. This position offers a comprehensive benefits package and a supportive work environment.

Benefits

Medical Coverage

Dental Coverage

Vision Coverage

Life Insurance

401k Contributions

Incentive and Recognition Programs

Qualifications

• Coding certification required; prior coding experience preferred.
• Knowledge of medical terminologies and coding guidelines essential.

Responsibilities

• Analyze health insurance benefits to apply medical codes accurately.
• Provide guidance to junior analysts and support audits for compliance.

Skills

Medical Coding

Critical Thinking

Communication Skills

Problem-Solving Skills

Time Management

Education

High School Diploma or GED

Coding Certification (AAPC or AHIMA)

Bachelor's Degree in a Related Field

Tools

Microsoft Outlook

Microsoft Word

Microsoft Excel

Microsoft PowerPoint

Adobe Acrobat

Job description

The Sr Claims Coding Analyst’s primary responsibilities require independent judgement in making complex coding-based decisions on claims and appeals to maintain and enhance Healthfirst’s claims editing systems in ensuring proper claims payments, reviewing, researching, and responding to written and emailed correspondence from providers regarding claim denials, and acting as a subject matter expert handling more complex provider issues. The Sr. Analyst will work as a first point of contact and provide day-to-day guidance to more junior Claims Coding Analysts. They are involved in setting Healthfirst claims policy and ensure that Healthfirst payment policy is aligned with CMS (Centers for Medicare and Medicaid Services), New York State Department of Health (NYSDOH), and all CPT, HCPCS, and ICD-10 coding guidelines, among others.

Duties & Responsibilities:

• Analyze and interpret health insurance benefits and coverage details to apply appropriate medical codes.
• Accurately assign procedure (CPT, HCPCS) and diagnosis codes (ICD-10) to represent patient services, treatments, copays, and coinsurance.
• Verify coding accuracy to support compliant billing and prevent claim denials and ensure accurate claim adjudication.
• Collaborate with clinical, claims, and benefits teams to clarify appropriate claim coverage and denials as published within the plan materials.
• Maintain up-to-date knowledge of coding guidelines, insurance policies, and industry regulations.
• Support audits, compliance checks, and quality assurance initiatives to ensure coding accuracy.
• Provide coding guidance and training for other team members as needed.
• Additional duties as assigned.

Minimum Qualifications:

• Coding certification from either American Academy of Professional Coders (AAPC), Certified Professional Coders (CPC), or American Health Information Management Association (AHIMA).
• Previous coding work experience.
• High school diploma or GED from an accredited institution.

Preferred Qualifications:

• 5-10 years of experience in medical coding, with a focus on benefits and insurance-related coding.
• Prior experience with LCDs, NCDs, and Medicaid coverage determinations.
• Prior experience with multiple Medicare and Medicaid physician, hospital, AMB Surgery, DME, and vaccination ambulance fee schedules.
• Prior experience with multiple claims scrubbers to ensure coding guidelines are followed.
• Prior experience in a health insurance plan.
• Prior experience in New York Medicaid Insurance Plans.
• Bachelor’s degree in a related field.
• Time management, critical/creative thinking, communication, and problem-solving skills.
• Demonstrated professional writing, electronic documentation, and assessment skills.
• Intermediate Outlook, Basic Word, Excel, PowerPoint, and Adobe Acrobat skills.
• Knowledge of anatomy and pathophysiology medical terminologies.

WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability, or any other protected Federal, State/Province, or Local status unrelated to the performance of the work involved.

If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to [e-mail] or calling 212-519-1798. In your email, please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within Healthfirst Management Services will be reviewed at the email address and phone number supplied. Thank you for considering a career with Healthfirst Management Services.

Hiring Range*:

• Greater New York City Area (NY, NJ, CT residents): $81,100 - $117,470
• All Other Locations (within approved locations): $71,600 - $106,505

As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision.

In addition to your salary, Healthfirst offers employees a full range of benefits such as medical, dental, and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live.

*The hiring range is defined as the lowest and highest salaries that Healthfirst in “good faith” would pay to a new hire, or for a job promotion, or transfer into this role.