Claims Coding Analyst Senior

HealthPartners is hiring a Senior Claims Coding Analyst. The Senior Coding Analyst provides advanced expertise in coding compliance, claims adjudication accuracy, and coding system governance. This role ensures the claims processing system accurately reflects industry-standard coding requirements including CPT, HCPCS, ICD-9, ICD-10, and related code sets to maintain regulatory compliance. The Senior Analyst supports evaluation of new codes, regulatory updates, and plan-specific policies, while investigating complex claims to determine reimbursement accuracy and identify provider billing trends and errors. This position also leads coding system enhancements, supports integration of vendor editing solutions, and drives revenue optimization through coding accuracy and system configuration.

MINIMUM QUALIFICATIONS:

Education, Experience or Equivalent Combination:

• Expert-level completion of Medical Coding Program with certification (AAPC or AHIMA equivalent: CPC, CCA, CCS)
• Minimum 5 years of coding experience across multiple patient visit types
• Minimum 5 years experience working with HMO, fully insured, indemnity, and government programs
• Prior experience in medical claims processing and adjudication
• Experience using coding software platforms and system editing tools
• Demonstrated ability to independently analyze and adjudicate complex claims scenarios

Licensure/ Registration/ Certification:

• CPC, CCA, CCS or equivalent (required)

Knowledge, Skills, and Abilities:

• Advanced knowledge of CPT, HCPCS, ICD-10, revenue codes, and claim formats (837P/837I)
• Strong understanding of anatomy, physiology, disease processes, and medical billing practices
• Knowledge of COB rules including Medicare regulations
• Experience with vendor coding software, claims processing systems, and encoder tools
• Strong analytical, trend analysis, and problem-solving capabilities
• Ability to make independent decisions and complex judgment calls
• Strong organizational, planning, and prioritization skills
• Proficient in Microsoft tools and data analysis
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  Effective communication skills across technical and business stakeholders

  
  

PREFERRED QUALIFICATIONS:

Education, Experience or Equivalent Combination:

• Bachelor's degree in a related field
• 7+ years of experience in the healthcare industry

Licensure/ Registration/ Certification:

• Advanced or specialty coding certifications preferred

Knowledge, Skills, and Abilities:

• Deep familiarity with coding governance, audit processes, and reimbursement methodologies
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  Experience supporting policy development and coding compliance initiatives

  
  

ESSENTIAL DUTIES:

1. (25%) Advanced Coding Compliance & Claims Adjudication

• Review complex claims for coding accuracy, medical appropriateness, and reimbursement integrity
• Approve or deny claims based on coding guidelines and policy requirements
• Resolve claim processing errors related to code validation during adjudication
• Ensure compliance with HIPAA and industry coding standards across all claim types

1. (20%) Coding System Governance & Optimization

• Administer, maintain, and audit coding systems and vendor editing software
• Support implementation of new, revised, and deleted code sets including CPT pairs
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  Lead testing, validation, and deployment of coding system updates

  Ensure system configurations align with regulatory,business requirements, and current coding requirements

1. (20%) Analysis, Trend Identification & Revenue Optimization

• Perform trend analysis to identify billing patterns, reimbursement impacts, and revenue opportunities
• Evaluate coding edits and business rules to ensure optimal system performance
• Identify opportunities to reduce claim inventory and improve financial outcomes
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  Support data-driven decision making through analytics and reporting

  
  

1. (15%) Stakeholder Leadership & Cross-functional Support

• Serve as subject matter expert for coding across Claims, Sales, Contracting, and other departments
• Represent the organization in internal committees and external industry forums
• Support policy development with Medical Policy, Government Programs, and compliance teams
• Communicate coding outcomes and provide guidance on complex issues

1. (10%) Vendor & System Integration Management

• Serve as primary contact for coding software vendors
• Collaborate with Business Systems Analysts and IT to design and implement system enhancements
• Support integration and optimization of coding software within claims platforms

1. (10%) Training, Mentorship & Documentation

• Provide training, mentorship, and work direction to team members
• Maintain accurate documentation of coding policies, procedures, and system changes
• Ensure audit readiness through comprehensive recordkeeping of coding updates