Remote – US
Change Healthcare is a leading healthcare technology company with a mission to inspire a better healthcare system. We deliver innovative solutions to patients, hospitals, and insurance companies to improve clinical decision making, simplify financial processes, and enable better patient experiences to improve lives and support healthier communities.
- Fully Remote – U.S.
The Payment Integrity Coding Analyst researches and interprets healthcare correct coding using regulatory requirements and guidance related to CMS, CPT/AMA and other major payer policies. They also use internal business rules to prepare written documentation of findings through medical record review.
The Coding Analyst possesses an overall understanding of all coding principles, including facility, provider and DME type coding and provide health care payers with a total claim management solution. Typically, 90% of a Coding Analyst’s time is spent performing coding and documentation review and 10% spent performing other tasks as assigned.
- Conduct coding reviews of medical records and supporting documentation against submitted claims, for individual provider and facility claims, to determine coding and billing accurate for all products.
- Process and/or review claims in a timely manner utilizing client specific coding and billing requirements that meet or exceed production and quality goals.
- Participate in process improvement activities and encourage ownership of and group participation in improvement initiatives
- Analyze medical documents to evaluate potential issues of fraud and abuse.
- Document coding review findings within investigative case tracking system and maintains thorough and objective documentation of findings.
- Serve as a coding resource and provide coding expertise and guidance to entire investigation and/or clinical team
- Monitor, track, and report on all case work.
- Communicate determinations verbally and/or in writing to appropriate business department as required by department internal workflow policies
- Identify and recommend opportunities for cost savings and improving outcomes.
- Coordinate activities with varying levels of leadership including the investigative team, legal counsel, internal and external customers, law enforcement and regulatory agencies, and medical professionals through effective verbal and written communications.
- Research and interpret correct coding guidelines and internal business rules to respond to customer inquiries, and monitors CMS and major payer coding and reimbursement policies.
- High School Diploma AND 4 years of professional work experience
- 3+ years’ experience in medical coding with primary focus in facility and pro fee coding
- Coding credentials: RHIA, RHIT, CCS-P, CCS or CPC
- Experience in reviewing, analyzing, and researching coding issues
- Advance proficiency in Microsoft Office skills including Outlook, Excel, and Word
- Associate Degree or equivalent in Health Information Management
- Experience with reimbursement policy and/or claims
- Excellent communication skills both verbal and written with a high attention to detail.
- Proficiency in navigating various computer applications with the ability to ramp up quickly.
- Ability to establish good customer relationships with trust and respect.
- Good interpersonal skills.
- Self-starting and independent, able to stay focused while working remotely.
- Attention to detail is critical
Working Conditions/Physical Requirements:
- General office demands
- Flexible work environments
- Ready, Set, Grow Career Development Center & access to Change Healthcare University for continuous professional learning & development with more than 5,000 training assets
- Volunteer days, employee giving and matching gifts programs, community awards and dollars for doers, community partnerships
- Employee wellbeing programs and generous health plans
- Educational assistance programs
- US 401(k) or Group RRSP (Canada) savings plans with matching employer contributions
- Be sure to ask our Talent Advisors for more information on location specific benefits and paid time off policies
- *Eligibility for some benefits may be limited or not available for part-time employees, be sure to speak with your Talent Advisor.
Diversity and Inclusion:
- At Change Healthcare, we include all. We celebrate diversity and inclusivity, respect each other and value our unique experiences. By being our authentic selves, we bring different perspectives into our work and relationships.
- Business Resource Groups (BRGs) play a central role in advancing diversity and inclusion at Change Healthcare. They deepen our understanding of different cultures, people, and experiences, and help foster an inclusive workplace. Change offers eight (8) BRGs.