Coding Business Analyst II - Repository Updates

Position Purpose

Perform various analysis and interpretation to link business needs and objectives for assigned function. Responsible for payment integrity repository updates and ensuring it remains up to date and accurate.

Responsibilities

• Review, analyze, and interpret coding, reimbursement, and regulatory guidelines to ensure organizational compliance and payment integrity.
• Develop, implement, and maintain Payment Policies, reimbursement methodologies, and claims editing logic to support accurate claims adjudication.
• Monitor, report on, and track regulatory, coding, and policy updates, ensuring timely implementation and communication of changes across impacted stakeholders.
• Support business initiatives through data analysis, identification of implementation barriers and user acceptance testing of new systems.
• Identify and analyze user requirements, procedures, and problems to improve existing processes.
• Perform detailed analysis on assigned projects, recommend potential business solutions and assist with implementation.
• Identify ways to enhance performance management and operational reports related to new business implementation processes.
• Develop and incorporate organizational best practices into business applications.
• Lead problem solving and coordination efforts between various business units.
• Assist with formulating and updating departmental policies and procedures.
• Performs other duties as assigned.
• Complies with all policies and standards.

Qualifications

• Bachelor's degree in related field or equivalent experience.
• 2+ years of business process analysis, preferably healthcare (i.e. documenting business process, gathering requirements) or claims payment/analysis experience.
• Knowledge of managed care information systems and experience in benefits, pricing, contracting or claims preferred.
• Knowledge of provider reimbursement methodologies preferred.
• Previous structured testing experience preferred.

Preferred Qualifications

• Coding certification such as a CPC or similar.
• Claims coding research experience.
• Claims research experience.
• Excel skills with pivot tables and VLOOKUPs.
• Smartsheet experience.

Pay

$56,200.00 - $101,000.00 per year

Benefits

• Competitive pay
• Health insurance
• 401K and stock purchase plans
• Tuition reimbursement
• Paid time off plus holidays
• Flexible approach to work with remote, hybrid, field or office work schedules