Serving as a Medical Coding subject matter expert, the full time remote Program Integrity Coding & Research Analyst will analyze complex provider claims submissions, resolve coding issues, and oversee quality audits while collaborating with various stakeholders.
Key responsibilities: Analyze complex provider claims submissions using CPT, ICD10, HCPCS, and DRG coding rules Lead root cause analysis of provider claim issues and oversee quality audit programs for internal coding validation Develop and implement an annual audit plan for high-risk providers, ensuring compliance and accuracy in claims processing Required qualifications: Bachelor's degree in Business Administration or related field, or equivalent relevant work experience Seven (7) years of experience in medical coding, including program integrity coding audits Five (5) years of experience with Medicaid policy development and analysis preferred Experience with reimbursement methodologies such as APC, DRG, and OPPS required Certified Professional Coder (CPC) or equivalent billing/coding designation required