coding quality analyst

St. Mary's Medical Center - Huntington, WV

<div>
 Marshall Health Network's Health Information Management department is seeking a PRN Coder Analyst IV.
 <br/>
 <br/>
 <strong>
  System Specific Duties And Responsibilities
 </strong>
 <br/>
 <br/>
 <ul>
  <li>
   Assign accurate diagnosis and procedure codes using ICD-10-CM/PCS, CPT, and/or HCPCS for reimbursement, compliance, and reporting purposes.
  </li>
  <li>
   Utilizes coding guidelines set up by government agencies dealing with the coding of health information.
  </li>
  <li>
   Demonstrates, promotes, and monitors for high standards of quality and productivity; focuses on quality results first.
  </li>
  <ul>
   <li>
    Maintains a standard of productivity that consistently meets or exceeds 98% of productivity.
   </li>
   <li>
    Maintains a standard or quality that consistently meets or exceeds 95% accuracy rate.
   </li>
  </ul>
  <li>
   Proficient to Expert level knowledge of ICD-10-CM, ICD-10-PCS, CPT, and HCPCS code sets.
  </li>
  <li>
   Proficient to Expert level knowledge of MS-DRG and APR-DRG groupers and Medicare&rsquo;s inpatient prospective payment system (IPPS) and outpatient prospective payment system (OPPS).
  </li>
  <li>
   Mentors&rsquo; new hires and/or participates in the cross-training of coding professionals as requested.
  </li>
  <li>
   Participates in departmental meetings. Responsible for reading meeting minutes or handouts as provided.
  </li>
  <li>
   Completes coding education sessions as required in addition to maintaining educational requirements for credential maintenance.
  </li>
  <li>
   Contributes to team efforts for the reduction of our combined DNFC.
  </li>
  <li>
   Uses resources (people, supplies, environmental) in a responsible cost-effective manner. Uses own time and that of others effectively.
  </li>
  <li>
   Demonstrates competency with all necessary computer systems and applications.
  </li>
  <li>
   Demonstrates understanding and sensitivity to compliance issues related to the corporate compliance plan.
  </li>
  <li>
   Collaborate with billing office, finance, revenue integrity, CDI, HIM supervisors/techs, case management, information technology, compliance, quality, and other departments as needed to resolve issues/opportunities that have been identified during or after the coding process.
  </li>
  <li>
   Must possess strong interpersonal communication skills and communicate honestly.
  </li>
  <li>
   Ability to analyze and interpret complex data.
  </li>
  <li>
   Adjusts and is flexible to meeting changing work needs and demands. Assumes other duties as necessary to support the efforts of the health system.
  </li>
  <li>
   Refers coding related issues or concerns to supervisor.
  </li>
  <li>
   Maintains a high degree of ethics, integrity, and confidentiality.
  </li>
  <li>
   Appreciates, celebrates, and values diversity.
  </li>
  <li>
   Follow the code of Ethics and the Standards of Ethical Coding developed by the American Health Information Management Association and/or the Code of Ethics by the American Academy of Professional Coders.
   <br/>
  </li>
 </ul>
 <strong>
  Community Engagement
  <br/>
  <br/>
 </strong>
 <ul>
  <li>
   Active Membership to American Health Information Management Association (AHIMA) or American Academy of Professional Coders (AAPC)
  </li>
 </ul>
</div>


Coder Analyst IV

Park Nicollet

<div><p>JOB DESCRIPTION</p>
<div><div>Park Nicollet is looking to hire a Coding Education &amp; Data Analyst to join our team! Come join us as a Partner for Good and help us make an impact on the care and experience that our patients and their families receive every day.</div><p><b>
Position Summary:</b></p><p>
Coding Education and Data Analyst is a highly visible position that is responsible for partnering system wide with Clinicians and clinic operations staff to support the HealthPartners Revenue Cycle. This role is responsible for understanding revenue cycle workflow, identifying opportunities to ensure all appropriate revenue is captured, and assist in closing documentation gaps for clinical departments supported by the professional coding team.</p><p>
Must have an in-depth understanding of coding and compliance rules and regulations and knowledge of the Electronic Health Record (EHR). Will provide system-wide support to Clinicians, clinical departments, and coders for CPT, HCPCS, ICD-10 CM coding systems and payor policy guidelines.</p><p><b>
Required Qualifications:</b></p><p><b>
Education, Experience or Equivalent Combination:</b></p><ul><li><div>
Must have completed a coding education program or must be a graduate from an associate or bachelor&rsquo;s degree program in health information.</div></li></ul><p><b>
Licensure/ Registration/ Certification:</b></p><ul><li><div>
Must have one of the following: RHIT (registered health information technician), RHIA (registered health information administrator), or coding certificate. Coding certificates can include: CCA (certified coding associate), COC (certified outpatient coder), CCS (certified coding specialist), CPC (certified professional coder), CCS-P (certified coding specialist-physician).</div></li></ul><p><b>
Knowledge, Skills, and Abilities:</b></p><ul><li><div>
Knowledge in using CPT, HCPCS, ICD-10 CM coding guidelines, rules and regulations, anatomy, physiology, basic disease processes and medical terminology</div></li><li><div>
Intermediate knowledge of Microsoft Office Suite. Ability to create excel spreadsheets and pivot tables for reporting and data analysis.</div></li><li><div>
Must be able to work independently, apply time management and critical thinking skills, and have strong decision-making skills.</div></li><li><div>
Must be a highly skilled and experienced coder who can independently research, analyze and understand large amounts of data, identify issues that have financial impact and provide opportunities to improve coding quality.</div></li><li><div>
Ability to present information in one-on-one and/or group settings and communicate information in a professional and confident manner.</div></li><li><div>
Must have a thorough understanding of revenue cycle stream.</div></li></ul><p><b>
Preferred Qualifications:</b></p><p><b>
Education, Experience or Equivalent Combination:</b></p><ul><li><div>
Three years coding experience</div></li><li><div>
Epic experience preferred</div></li><li><div>
Experience working with online coding resources and other related software programs.</div></li><li><div>
Strong E &amp; M coding experience</div></li><li><div>
Ability to present and communicate information in either individual and/or group settings in a professional and confident manner.</div></li></ul><p><b>
Knowledge, Skills, and Abilities:</b></p><p><b>
Benefits:</b></p><p>
Park Nicollet offers a competitive benefits package (for eligible positions) that includes medical insurance, dental insurance, a retirement program, time away from work, insurance options, tuition reimbursement, an employee assistance program, onsite clinic and much more!</p></div></div>
<br><div><p>ABOUT US</p>
<div><div>At HealthPartners we believe in the power of good &ndash; good deeds and good people working together. As part of our team, you&rsquo;ll find an inclusive environment that encourages new ways of thinking, celebrates differences, and recognizes hard work.</div>
<p>
We&rsquo;re a nonprofit, integrated health care organization, providing health insurance in six states and high-quality care at more than 90 locations, including hospitals and clinics in Minnesota and Wisconsin. We bring together research and education through HealthPartners Institute, training medical professionals across the region and conducting innovative research that improve lives around the world.</p>
<p>
At HealthPartners, everyone is welcome, included and valued. We&rsquo;re working together to increase diversity and inclusion in our workplace, advance health equity in care and coverage, and partner with the community as advocates for change.</p>
<p><b>
Benefits Designed to Support Your Total Health</b><br>
As a HealthPartners colleague, we&rsquo;re committed to nurturing your diverse talents, valuing your dedication, and supporting your work-life balance. We offer a comprehensive range of benefits to support every aspect of your life, including health, time off, retirement planning, and continuous learning opportunities. Our goal is to help you thrive physically, mentally, emotionally, and financially, so you can continue delivering exceptional care.</p>
<p>
Join us in our mission to improve the health and well-being of our patients, members, and communities.</p>
<p></p>
<p>We are an Equal Opportunity Employer and do not discriminate against any employee or applicant because of race, color, sex, age, national origin, religion, sexual orientation, gender identify, status as a veteran and basis of disability or any other federal, state or local protected class.</p></div></div>
<br><div><p>JOB INFO</p>
<div><div><div><ul><div><div>Job Identification</div>
<div>119097</div>
</div><div><div>Organization</div>
<div>Park Nicollet Clinics, HealthPartners Enterprise</div>
</div><div><div>Posting Date</div>
<div>04/13/2026, 02:57 PM</div>
</div><div><div>Locations</div>
<div> <div></div><div><div>Work@Home Minnesota
</div></div></div></div><div><div>Work Schedule</div>
<div>Monday through Friday, Daytime hours</div>
</div><div><div>Hours Per Week/FTE</div>
<div>40 hrs weekly / 1.0 FTE</div>
</div><div><div>Job Shift</div>
<div>Day</div>
</div><div><div>Position Type</div>
<div>Full-time regular</div>
</div><div><div>Job Category</div>
<div>Administrative</div>
</div><div><div>Department</div>
<div>HIM Coding</div>
</div><div><div>Pay Range</div>
<div>$31.38 - $47.06 hourly</div>
</div><div><div>Pay Range Statement</div>
<div>Compensation is based on the level and requirements of the role. Pay within our ranges may also be determined by education, experience, knowledge, skills, location, and abilities as well as internal equity. Hired candidates may be eligible to receive additional compensation based on role (e.g., shift differential, bonus, sales incentive, productivity pay, etc.).</div>
</div><div><div>Overtime Eligibility Status</div>
<div>Exempt</div>
</div><div><div>Worker Type</div>
<div>Employee</div></div></ul></div></div></div></div>

Coding Education and Data Analyst

Urology Centers of Alabama

<div><p><b>General Summary</b></p><p>
We are seeking a highly analytical and detail-oriented Data Analyst to support a large, 30-shareholder urology practice with integrated medical oncology, radiation oncology, and multiple ancillary service lines. This role is responsible for transforming data from clinical, operational, and financial systems into actionable insights that drive performance, efficiency, and strategic decision-making.</p><p>
The ideal candidate will have experience working with healthcare data ecosystems, including practice management, EHR, and oncology-specific systems.</p><p><b>
Key Responsibilities</b></p><p>
Data Management &amp; Integration</p><ul><li>Extract, validate, and integrate data from multiple systems, including:</li></ul><p>
o Allscripts (Practice Management)</p><p>
o Veradigm (EHR)</p><p>
o ARIA Oncology Information System (Radiation Oncology)</p><ul><li>Develop and maintain data pipelines and standardized datasets for reporting and analytics</li><li>Ensure data integrity, consistency, and compliance with healthcare regulations (e.g., HIPAA)</li></ul><p>
</p><p><b>Reporting &amp; Analytics</b></p><ul><li>Design and maintain dashboards and reports for:</li></ul><p>
o Provider productivity (wRVUs, encounters, procedures)</p><p>
o Financial performance (collections, charges, payer mix, denials)</p><p>
o Radiation oncology utilization and throughput</p><p>
o Medical oncology infusion metrics</p><p>
o Ancillary service line performance (imaging, lab, pharmacy, etc.)</p><ul><li>Deliver recurring and ad hoc reports to physicians, executives, and operational leaders</li><li>Identify trends, anomalies, and opportunities for improvement</li></ul><p>
</p><p>Operational &amp; Financial Insights</p><ul><li>Analyze revenue cycle performance including:</li></ul><p>
o Charge capture</p><p>
o Coding patterns</p><p>
o Denial trends and reimbursement optimization</p><ul><li>Support budgeting, forecasting, and strategic planning initiatives</li><li>Partner with leadership to evaluate service line profitability and expansion opportunities</li></ul><p>
</p><p>Clinical &amp; Quality Analytics</p><ul><li>Support quality reporting and value-based care initiatives</li><li>Analyze clinical outcomes, treatment patterns, and patient flow</li><li>Assist with registry reporting and compliance metrics (as applicable)</li></ul><p>
</p><p>Stakeholder Collaboration</p><ul><li>Work closely with physicians, administrators, billing teams, and IT</li><li>Translate complex data into clear, actionable insights for non-technical audiences</li><li>Serve as a liaison between clinical operations and technical systems</li></ul><p>
</p><p>Required Qualifications</p><ul><li>Bachelor&rsquo;s degree in Data Analytics, Health Informatics, Business, or related field</li><li>3+ years of experience in healthcare data analytics (multi-specialty or oncology preferred)</li><li>Strong experience with:</li></ul><p>
o SQL and relational databases</p><p>
o Excel (advanced)</p><p>
o Data visualization tools (Power BI, Tableau, or similar)</p><ul><li>Experience working with EHR and PM systems (preferably Allscripts/Veradigm environments)</li><li>Understanding of healthcare financial and operational metrics (wRVUs, CPT/ICD coding, revenue cycle)</li></ul><p>
Key Competencies</p><ul><li>Analytical thinking and problem-solving</li><li>Attention to detail and data accuracy</li><li>Ability to manage large, complex datasets</li><li>Strong communication and data storytelling skills</li><li>Ability to work in a fast-paced, physician-driven environment</li></ul><p>
Why This Role Matters</p><p>
This position plays a critical role in helping a complex, high-volume specialty practice optimize performance across urology, medical oncology, and radiation oncology. The Data Analyst will directly influence financial outcomes, operational efficiency, and patient care quality through data-driven insights.</p><p>
</p><p><b>Required Qualifications</b></p><ul><li>Bachelor&rsquo;s degree in Data Analytics, Health Informatics, Business, or related field</li><li>3+ years of experience in healthcare data analytics (multi-specialty or oncology preferred)</li><li>Strong experience with:</li></ul><p>
o SQL and relational databases</p><p>
o Excel (advanced)</p><p>
o Data visualization tools (Power BI, Tableau, or similar)</p><ul><li>Experience working with EHR and PM systems (preferably Allscripts/Veradigm environments)</li><li>Understanding of healthcare financial and operational metrics (wRVUs, CPT/ICD coding, revenue cycle)</li></ul><p>
</p><p><b>Preferred Qualifications</b></p><ul><li>Experience with oncology workflows (medical and/or radiation oncology)</li><li>Familiarity with radiation oncology data structures (e.g., ARIA)</li><li>Knowledge of ETL processes and data warehousing concepts</li><li>Experience with population health or value-based care analytics</li><li>Certification in healthcare analytics or data tools (e.g., CHDA, Power BI, Tableau)</li></ul></div>

Data Analyst

Norton Healthcare

<div>Responsibilities:
<div>
The Sr. Revenue Integrity Pharmacy Analyst is responsible for expert review of pharmacy related charge audits, denials, quarterly HCPCS updates, and value analysis. They will review and analyze pharmacy claims, collaborating with pharmacy IS, Billing and Managed Care to ensure compliance with billing regulations while maximizing reimbursement. Additionally they provide support and education to Pharmacy and Revenue Cycle teams on coding and documentation requirements. Strong attention to detail with extensive knowledge in Pharmacy billing, coding, payor policies, federal regulations and reimbursement methodologies are essential for this role.</div><div></div><div><b><br>
**This position offers a fully remote work opportunity. Employees in this role must reside in one of the following states to be considered for fully remote positions: Kentucky, Indiana, Missouri, Ohio, Tennessee, Alabama, Virginia, Mississippi, North Carolina, South Carolina**</b></div>
Qualifications:
<div><b>
Required:</b></div><ul><li>
Three years of experience in healthcare revenue cycle, clinic operations or pharmacy technician</li><li>
One of: CCA or CCS or CIC-ICD or COC or CPC or RHIA or RHIT</li></ul><div><b>
Desired:</b></div><ul><li>
One year of pharmacy experience</li></ul></div>

Senior Revenue Integrity Pharmacy Analyst, Revenue Integrity/Coding Administration, Days, Fully Remote

Openkyber

<div><p>OpenKyber, Inc., (OpenKyber), is searching for a Business Analyst for a CONTRACT assignment with one of our premier Regulatory clients in Rockville, MD, Tysons, VA or Washington D.C. The Business Analyst conducts moderate-to-high complexity analysis of automated surveillance systems that detect potential violations of regulatory rules. This role is responsible for understanding, validating, enhancing, and supporting surveillance patterns across multiple asset classes and regulatory domains. The analyst serves as the bridge between regulatory requirements and the technical implementation of surveillance logic, ensuring patterns produce accurate, complete, and defensible results. The analyst is expected to actively leverage generative AI tools to accelerate analysis, documentation, and automation - serving as the domain expert who directs AI capabilities while ensuring regulatory accuracy and completeness of all outputs.</p>
<b>Responsibilities :</b>
<ul><li>Surveillance Pattern Analysis &amp; Knowledge Management Reverse-engineers surveillance pattern source code to build comprehensive knowledge documentation covering data pipelines, business rules, exception logic, and output schemas</li>
<li>Maintains a knowledge base of surveillance patterns across multiple regulatory domains</li>
<li>Performs requirements-vs-code gap analysis to identify discrepancies between documented business requirements and implemented logic, flagging risks to surveillance coverage</li>
<li>UAT &amp; Release Validation Validates new surveillance pattern releases by comparing production vs. UAT outputs, analyzing exception counts, volumes, and firm-level impacts</li>
<li>Builds local testing environments to execute query scripts against sample data, enabling independent verification of pattern logic before production deployment</li>
<li>Designs multi-scenario test cases covering edge cases to ensure comprehensive test coverage</li>
<li>Packages release artifacts (scripts, QC results, requirements documentation) following standardized release structures</li>
<li>Ad-Hoc Data Analysis &amp; Investigation Support Writes complex queries to support analyst investigations into surveillance exceptions</li>
<li>Performs firm-level statistical analysis and produces reports for management review</li>
<li>Maintains reference data sets used by downstream surveillance patterns</li>
<li>Assesses data incident impacts by cross-referencing affected data sources against the surveillance pattern dependency map</li>
<li>Process Automation &amp; Tooling Develops automation tools for ticket management, release documentation, and workflow optimization</li>
<li>Builds local testing frameworks that replicate production environments for rapid pattern testing and iteration</li>
<li>Creates data visualization and comparison reports with interactive views, summary statistics, and color-coded differentials</li>
<li>Generative AI Integration &amp; Prompt Engineering Leverages AI coding assistants as a force multiplier - directing AI agents to reverse-engineer source code, build knowledge documentation, generate test frameworks, and produce data comparison reports</li>
<li>Designs structured AI workflows including pattern study pipelines, workflow assistants, and automated documentation generation</li>
<li>Maintains a curated AI project workspace with standing instructions, conventions, and context files that enable consistent, high-quality AI-assisted output</li>
<li>Coordinates multi-step analytical tasks through AI - from reading source code and drafting requirements, to generating test harnesses and producing comparison reports - reducing turnaround from days to hours</li>
<li>Evaluates and validates AI-generated outputs for regulatory accuracy before use in production workflows</li>
<li>Project Management Support Manages work across project tracking boards, tracking enhancement tickets, bug fixes, and new pattern development</li>
<li>Drafts and updates Business Requirements Documents (BRDs) for surveillance pattern enhancements</li>
<li>Coordinates release activities including documentation, QC, and UAT sign-off tracking</li>
</ul><p>OTHER RESPONSIBILITIES Participates on special projects as assigned. Serves as a mentor for less experienced analysts. Keeps management updated on notable trends in industry practices, regulatory changes, and emerging technology capabilities (including AI tooling). Champions adoption of AI-assisted workflows within the team.</p>
<b>Required Skills :</b>
<ul><li>Bachelor's degree and 5+ years of experience in financial regulatory technology, surveillance systems, or capital markets data analysis</li>
<li>Proficiency in SQL for large-scale data analysis on distributed platforms</li>
<li>Proficiency in at least one scripting/programming language for data analysis, automation, and tool development</li>
<li>Experience reading and interpreting complex data processing pipelines and business logic in source code</li>
<li>Strong analytical skills with the ability to independently investigate data discrepancies and validate system outputs</li>
<li>Excellent documentation skills - ability to translate complex technical implementations into clear business-facing knowledge documents</li>
<li>Advanced proficiency in spreadsheet tools for business and operational analysis</li>
</ul><b>Preferred Skills :</b>
<ul><li>Major in Business Administration, Finance, Computer Science, or related field; advanced degree preferred</li>
<li>Knowledge of SEC/FINRA regulatory rules and reporting requirements</li>
<li>Experience with distributed query engines and big data platforms</li>
<li>Experience with project management and documentation tools and their APIs</li>
<li>Familiarity with surveillance pattern architectures (exception generation, scoring, aggregation, reconciliation)</li>
<li>Experience with source code management and release branch workflows</li>
<li>Experience leveraging generative AI tools (LLMs, AI coding assistants) to accelerate data analysis, code comprehension, documentation, and automation workflows</li>
<li>Ability to design effective AI prompts and structured project contexts that produce reliable, domain-accurate outputs in a regulated environment</li>
</ul><p>OpenKyber is a technology and resource solutions provider driven to stand out. We are a women-owned business. Our mission: to solve big IT problems with a more personal, boutique approach. Each year, we match consultants like you to more than 1,000 engagements. When we say let's work better together, we mean it. You'll join a diverse team built on these core values: customer service, employee development, and quality and integrity in everything we do. Be yourself, love what you do and find your passion at work.</p>
<p>SGA is an Equal Opportunity Employer and does not discriminate on the basis of Race, Color, Sex, Sexual Orientation, Gender Identity, Religion, National Origin, Disability, Veteran Status, Age, Marital Status, Pregnancy, Genetic Information, or Other Legally Protected Status. We are committed to providing access, equal opportunity, and reasonable accommodation for individuals with disabilities in employment, and our services, programs, and activities.</p>
<p>Please visit our company to request an accommodation or assistance regarding our policy.</p>
<p><b>For applications and inquiries, contact:</b> hirings@openkyber.com</p></div>

AI Model Deployment Administrator

LanceSoft, Inc.

<div>
 <p>
  Job Title: Clinical Data Analyst
 </p>
 <p>
  Job Location: Candidate must be a current resident of South Carolina
 </p>
 <p>
  Job Duration: 12+ Months Contract
 </p>
 <p>
  Pay rate: $84/hrs. on W2 (All inclusive)
 </p>
 <p>
  <br/>
 </p>
 <p>
  Job Responsibilities:
 </p>
 <p>
  <br/>
 </p>
 <p>
  The principal duties of this position are to assist with the CPT/HCPCS and ICD-10 code maintenance.
 </p>
 <p>
  <br/>
 </p>
 <p>
  Specific duties include, but are not limited to:
 </p>
 <ul>
  <li>
   Collaborates with internal recipient and owner of initial review of codes to determine scope of changes for planning and timely completion.
  </li>
  <li>
   Receives listings of codes changes distributed to the Reference Administration and Medicaid Program staff for review and analysis.
  </li>
  <li>
   Serves as an approver within the code change / update process following the internal initiation of annual (and quarterly) updates from CMS of all ICD-10, CPT/HCPCS coding changes.
  </li>
  <li>
   Serves as lead for meetings with Agency personnel, stakeholders, and process owners.
  </li>
  <li>
   Serves as an agency subject matter expert (SME) for medical coding methodologies, Medicaid policy, and related topics.
  </li>
  <li>
   Researches business rules, requirements, and models to complete initial analysis and recommendations.
  </li>
  <li>
   Maintains business rules, requirements, and models in a repository.
  </li>
  <li>
   Collaborates with team to ensure process documentation is complete, owner and stakeholder, as needed, training content is complete and routinely updated.
  </li>
  <li>
   Participates in agency projects and related initiatives requiring subject matter expertise.
  </li>
 </ul>
 <p>
  Other duties, as assigned or required.
 </p>
 <p>
  <br/>
 </p>
 <p>
  <strong>
   Required Skills (rank in order of Importance):
  </strong>
 </p>
 <p>
  <br/>
 </p>
 <ul>
  <li>
   5 years&rsquo; experience in healthcare insurance; medical review, program integrity, or appeals.
  </li>
  <li>
   5 years&rsquo; experience working with IT developers/programmers in a payor environment.
  </li>
  <li>
   5 years&rsquo; experience Medical Coding in payer environment.
  </li>
  <li>
   3 years&rsquo; clinical experience in a healthcare environment (Strong clinical assessment and critical thinking skills.)
  </li>
  <li>
   5 years&rsquo; strong knowledge of ICD/CPT/HCPCS translation and coding methodologies.
  </li>
 </ul>
 <p>
  <br/>
 </p>
 <p>
  <strong>
   Preferred Skills (rank in order of Importance):
  </strong>
 </p>
 <p>
  <br/>
 </p>
 <ul>
  <li>
   5 years&rsquo; experience in policy remediation.
  </li>
  <li>
   5 years&rsquo; Medical Claim processing systems experience.
  </li>
  <li>
   Knowledge of Microsoft Office (Word, Excel, PowerPoint, Optum Encoder and / or other medical coding software programs).
  </li>
 </ul>
 <p>
 </p>
</div>


Clinical Data Analyst

Heritage Medical Associates, P.C.

<div><p><b>SUMMARY: Insurance Analysts demonstrate thorough knowledge of the claims revenue cycle. The Insurance Analyst position is responsible for answering patient and staff inquiries, reviewing outstanding and/or denied insurance claims, submitting insurance appeals, and maintaining assigned insurance queues.
</b></p><p></p><p><b>Insurance Analyst must have the ability to provide excellent Customer Service to patients and staff and correctly answer a question regarding insurance and balances. The type of questions may include, but are not limited to insurance participation, correct coding guidelines, carrier specific medical policies, and denial codes, review of accounts for payment application, as well as the ability to assist patient and/or staff in understanding insurance benefits and how the benefits were applied to the service(s) received at HMA.
</b></p><p></p><p><b>ESSENTIAL DUTIES AND RESPONSIBILITIES include the following: (Other duties maybe assigned.)</b></p><p>
</p><ul><li>Work denied claims through the practice management queue</li><li>
Processing of denials in a timely and accurate manner</li><li>
Correct and any denied claim, including submitting additional information or documentation as requested</li><li>
Creation and submission of appeals</li><li>
Communicate with insurance companies, as needed</li><li>
Query provider in a timely manner, as needed</li><li>
Interpret and apply compliance guidelines to maintain billing integrity</li><li>
Update and maintain patient account information and have the ability to make adjustments as necessary, and according to company policy</li><li>
Receive, sort and work incoming correspondence daily</li><li>
Identify and communicate trends in denials to management</li><li>
Answer patient questions, inquiries and concerns regarding their accounts; verify balances and refunds for accuracy, and ensure timely follow up with patient, as needed.</li><li>
Audit accounts referred by Patient Service Representatives and Patient Accounts, as well as provide a response in a timely manner</li><li>
Utilize the Insurance Analyst work queues to follow up on accounts until the account has been satisfactorily resolved.
</li><li>Post corrected claims and any payments associated with that correction</li><li>
Transfer credits in an account</li><li>
Follow HMA guidelines in applying self-pay discounts, charity and per request adjustments.
</li></ul><p></p><p><b>SUPERVISORY RESPONSIBILITIES:</b></p><p>
None</p><p>
</p><p><b>QUALIFICATIONS:
</b></p><ul><li>Strong Customer Service Skills</li><li>
Excellent telephone etiquette and skills</li><li>
Exceptional written and verbal communication skills</li><li>
Ability to work with little supervision</li><li>
Superior organizational skills</li><li>
Self motivated</li><li>
Ability to work in a cooperative manner with others</li><li>
Regular and predictable attendance</li></ul><p>
</p><p><b>EDUCATION and/or EXPERIENCE:</b></p><ul><li>
High school diploma</li><li>
3-5 years of third-party billing in a physicians office</li><li>
Knowledge of ICD-10/CPT Coding</li><li>
Experience in medical billing systems
</li><li>Must have thorough understanding of Medicare/Medicaid laws, managed care, and commercial health insurance</li></ul><p><b>
</b></p><h4 class="jobSectionHeader"><b>PHYSICAL DEMANDS:</b></h4><ul><li>
Must be able to walk to patient in physicians office and/or sit for 8 to 10 hours a day</li><li>
Requires regular walking, bending, pushing, pulling, twisting and lifting</li><li>
Must be able to lift at least 10-15lbs</li><li>
Ability to delineate between numeric numbers</li></ul><h2 class="jobSectionHeader"><b><i>
WORK ENVIRONMENT:</i></b></h2><ul><li>
Office environment-limited exposure to communicable diseases.
</li><li>No exposure to blood-borne pathogens or contaminated body fluids
</li><li>Fast paced environment</li></ul></div>

Insurance Analyst, Business Office, Nashville

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