Position Summary
The Code Edit Analyst creates consistency and efficiency in claims processing and data collection by applying appropriate diagnostic and procedural codes to individual patient health information. This role coordinates processing of medical services for Medical Necessity and Correct Coding Initiative requirements, applies advanced specialty coding knowledge, and analyzes patient medical records to ensure provider documentation conforms to legal and procedural requirements.
The analyst performs audits of complex medical records for coding and billing accuracy and supports the Billing Manager and other team members with reporting on audit outcomes, code errors, revenue impact, and data processing errors. The role also supports other Revenue Cycle Division and Performance Improvement initiatives, including contract compliance, charge description master, coding/pricing, and new product development.
Responsibilities include daily coding reviews, data collection for process improvement, identification of billing and coding problems, charge reviews, trend analysis, documentation of findings, and collaboration with departments to resolve variances and improve revenue cycle performance.
Minimum requirements include a bachelor's degree or higher in a health service-related discipline, or five years of extensive experience with a coding certificate in lieu of a degree. Previous auditing experience is preferred, and national certification relevant to Revenue Management or Coding is preferred.
Required knowledge and skills include:
- Proficiency in reimbursement methodologies, hospital information systems, and coding methodologies
- Ability to analyze complex medical records and identify billable services
- Strong quantitative, analytical, and organizational skills
- Understanding of medical records, professional and hospital claims, and the chargemaster
- Knowledge of ICD-10, HCPCS, and CPT-4 coding schemes
- Knowledge of UB-04/837 claim form loop and segments
- Understanding of charging and coding processes, compliance issues, and CMS guidance
- Medical terminology, anatomy, and physiology knowledge
- Strong oral and written communication skills
- Team-oriented interpersonal skills
- Knowledge of privacy and patient confidentiality requirements
- Certified Coding Specialist or Certified Procedural Coder preferred
Great benefits are offered. The position includes a Monday through Friday day shift schedule from 8:00 a.m. to 5:00 p.m. Remote work is available.
Location
North Carolina, US
Employment Type
Full-time
Experience Level
Senior
Remote work allowed
Yes
Posted
3 weeks ago