Medical Coding Policy Analyst

Job description

STAR Medical Auditing Services is a boutique consulting firm that provides Health Information Management (HIM) and Clinical services to various organizations in the healthcare ecosystem across the U.S. We pride ourselves in providing high-quality services that are tailored to our clients’ specific needs, while creating joyful experiences along the way by treating everyone with respect and care.

Must reside and be legal to work in the U.S.

Overview

The Medical Coding Policy Analyst is responsible for researching, interpreting, and translating federal, state, and commercial payer coding regulations into actionable internal policies and guidance. This role transforms policy criteria into rules that are applied during claims adjudication using APEA (Automated Policy Enforcement Application) including ensuring that clinical criteria are configured accurately. The ideal candidate is RN with coding credential, detail-oriented, analytical, and highly knowledgeable in ICD-10-CM, CPT, HCPCS, and regulatory guidance, with the ability to synthesize complex policy language into clear operational standards.

Essential Functions and Responsibilities:

• Complete conversion of laboratory policies into translation guide
• Conduct policy research to provide ongoing support of translation guide library
• Thoughtfully map rationale to bridge between laboratory policies and translation guide
• Monitor and interpret CMS transmittals, Federal Register updates, OIG work plans, MAC policies, and commercial payer guidelines.
• Analyze changes to ICD-10-CM, CPT, HCPCS, NCCI edits, and other coding frameworks.
• Actively participate in work teams to ensure overall deliverables meet the needs of both client and internal processes

Minimum Qualifications:

• Foundational understanding of how to interpret policy language
• Prefer prior experience in policy research and a developed skillset in policy writing and translation
• Extensive knowledge of medical terminology, anatomy, coding guidelines and clinical criteria with ability to integrate medical chart coding principles, clinical guidelines, and objectivity in policy review
• Knowledge of legal, regulatory, and policy compliance issues related to medical coding and billing procedures, and documentation including CMS guidelines
• Strong technical acumen and ability to understand, apply and manage processes
• Strong analytical abilities to interpret complex information.
• Ability to follow policies & procedures
• Excellent communication skills and writing abilities.
• Effectively utilizes tools and software programs to complete tasks.
• Meets or exceeds standards for productivity and quality
• Extensive knowledge of medical terminology, anatomy and coding guidelines
• Must be licensed RN
• Must have AHIMA/AAPC credential (CPC or CCS)
• Must be able to work 8am-5:30pm eastern Monday thru Friday

Segregation of Duties

Every employee is responsible to perform their duties and responsibilities in accordance with STAR’s values, policies and procedures, including but not limited to, Segregation of Duties Principles, HIPAA Security and Privacy, and any other applicable laws, rules and regulations.

Statement of Other Duties

This document outlines the essential functions, requirements, and responsibilities of the position, and is not intended to be a complete list of all tasks and duties. Employees may be requested to perform job related tasks other than those specifically listed in this description and may be required to perform any task requested by the supervisor or by management.

Pay: $40.00 - $44.00 per hour

Expected hours: 40.0 per week

Benefits:

• 401(k)
• Dental insurance
• Flexible spending account
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Parental leave
• Referral program
• Tuition reimbursement
• Vision insurance

Application Question(s):

• Do you reside in the U.S.A.?
• Do you have experience analyzing changes to ICD-10-CM, CPT, HCPCS, NCCI edits, and other coding frameworks?
• Do you have experience monitoring and interpreting CMS transmittals, Federal Register updates, OIG work plans, MAC policies, and commercial payer guidelines?
• Do you have active coding credential (CPC, CCS, etc)?
• Do you have a current and active RN license?

Work Location: Remote