HealthPartners is hiring a Claims Coding Analyst to support medical coding compliance, claims adjudication accuracy, and coding system integrity. The role ensures claims processing systems reflect current coding requirements, supports regulatory and policy updates, evaluates coding-related claim issues, and helps identify billing trends and errors. The position partners with internal stakeholders and external vendors to maintain system functionality and support accurate reimbursement and compliance outcomes.
Key responsibilities
- Review and evaluate claims for coding accuracy and medical appropriateness
- Approve or deny claims based on coding guidelines and policy requirements
- Resolve claim processing errors related to code validation during adjudication
- Monitor coding updates from CMS, NUBC, and other regulatory bodies
- Support implementation, testing, and validation of coding system updates
- Maintain and support coding systems, including vendor-managed platforms
- Analyze coding-related claim issues to identify billing trends, errors, and opportunities
- Conduct research to support new code implementation or policy changes
- Serve as a subject matter expert for coding questions across the organization
- Support claims, provider appeals, adjustment requests, and cross-functional teams
Minimum qualifications
- Completion of a Medical Coding Program with certification (AAPC or AHIMA equivalent such as CPC, CCA, or CCS), or ability to obtain within one year
- Minimum 2 years of coding experience across multiple patient visit types
- Experience in claims processing and medical billing within healthcare or insurance settings
- Experience with HMO, fully insured, indemnity, and government programs
- Ability to make independent decisions in claim coding and adjudication
Licensure and certification
- CPC, CCA, CCS, or equivalent required or obtained within one year of hire
Knowledge and skills
- Strong knowledge of CPT, HCPCS, ICD-10, revenue codes, and claim formats (837P/837I)
- Understanding of medical terminology, anatomy, physiology, and disease processes
- Knowledge of Coordination of Benefits rules, including Medicare regulations
- Experience using claims processing systems, encoder tools, and coding software
- Strong analytical, problem-solving, and trend analysis skills
- Solid organizational and planning capabilities
- Proficiency with Microsoft tools and data analysis
- Effective communication with internal stakeholders and external parties
Preferred qualifications
- Bachelor's degree in a related field
- 5+ years of healthcare experience
- Advanced or specialty coding certifications
- Experience with coding governance, reimbursement methodologies, and audit processes
HealthPartners offers a comprehensive benefits package designed to support total well-being, including health coverage, time off, retirement planning, and continuous learning opportunities. The organization also emphasizes work-life balance, inclusion, and professional growth.
Location
Minnesota, US
Employment Type
Full-time
Experience Level
Associate
Remote work allowed
No
Posted
1 week ago