Skip to content

General Information

Req ID
R020231
State
New York
Work Type
Hybrid

Description and Requirements

The Sr Claims Coding Analyst’s primary responsibilities require independent judgement in making complex coding-based decisions on claims and appeals to maintain and enhance Healthfirst’s claims editing systems in ensuring proper claims payments, reviewing, researching, and responding to written and emailed correspondence from providers regarding claim denials, and acting as a subject matter expert handling more complex provider issues. The Sr. Analyst will work as a first point of contact and provide day-to-day guidance to more junior Claims Coding Analysts. They are involved in setting Healthfirst claims policy and ensure that Healthfirst payment policy is aligned with CMS (Centers for Medicare and Medicaid Services), New York State Department of Health (NYSDOH), and all CPT, HCPCS, and ICD-10 coding guidelines, among others.

Duties & Responsibilities: 

  • Analyze and interpret health insurance benefits and coverage details to apply appropriate medical codes.
  • Accurately assign procedure (CPT, HCPCS) and diagnosis codes (ICD-10) represent patient services, treatments, copays, and coinsurance
  • Verify coding accuracy to support compliant billing and prevent claim denials and accurate claim adjudication
  • Collaborate with clinical, claims and benefits teams to clarify appropriate claim coverage and denials as published within the plan materials
  • Maintain up-to-date knowledge of coding guidelines, insurance policies, and industry regulations
  • Support audits, compliance checks, and quality assurance initiatives to ensure coding accuracy
  • Provide coding guidance and training for other team members as needed
  • Additional duties as assigned

Minimum Qualifications:    

  • Coding certification from either American Academy of Professional Coders (AAPC), Certified Professional Coders (CPC) or American Health Information Management Association (AHIMA)
  • Previous Coding work experience
  • High school diploma or GED from an accredited institution

Preferred Qualifications:

  • 5-10 years of experience in medical coding, with a focus on benefits and insurance-related coding
  • Prior experience with LCDs, NCDs and Medicaid coverage determinations
  • Prior experience with multiple Medicare and Medicaid physician, hospital, AMB Surgery, DME, vaccination Ambulance fee schedules
  • Prior experience with multiple claims scrubbers to ensure coding guidelines are followed
  • Prior experience in a health insurance plan
  • Prior experience in New York Medicaid Insurance Plans
  • Bachelor’s degree in related field
  • Time management, critical/creative thinking, communication, and problem-solving skills
  • Demonstrated professional writing, electronic documentation, and assessment skills
  • Intermediate Outlook, Basic Word, Excel, PowerPoint, Adobe Acrobat skills
  • Knowledge of anatomy and pathophysiology medical terminologies

Compliance & Regulatory Responsibilities: See Above

License/Certification: See Above

Hiring Range*:

  • Greater New York City Area (NY, NJ, CT residents): $81,100 - $117,470

  • All Other Locations (within approved locations): $71,600 - $106,505

As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision.

In addition to your salary, Healthfirst offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live.

*The hiring range is defined as the lowest and highest salaries that Healthfirst in “good faith” would pay to a new hire, or for a job promotion, or transfer into this role.

WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.