Job Description

Overview Coding Policy Analyst (Remote) at Providence Health & Services. The Coding Policy Analyst is responsible for coordinating technically detailed work that impacts operations and information systems within Providence Health Plan (PHP). This role will update and create Coding Policies and associated edit configurations within the PHP claims editing system, respond to provider and member appeals with appropriate rationale for Coding Policy edits, and monitor changes to codes, coding guidelines and regulations from external agencies. The analyst assists with implementing changes to the claims adjudication and editing software. Responsibilities Update and create Coding Policies and associated edit configurations within the PHP claims editing system. Respond to provider and member appeals with CPT, CMS, specialty society, Coding Policy, and/or other official documented rationale for Coding Policy edits. Monitor changes to codes, coding guidelines, and regulations from external agencies (e.g., AMA, CMS, Medicaid, specialty societies) and assist with implementing these changes to the claims adjudication and editing software. Qualifications Coding certification through AAPC (CPC) or AHIMA (CCS) upon hire. 5 years of experience directly related to CPT coding from chart extraction with a health care provider, a health insurance company, or a capitated managed care company. 5 years of excellent writing and grammar skills. 5 years of demonstrated experience in detailed coding applications, as well as Microsoft Office capabilities (Excel, Word, Access). Preferred Qualifications Bachelor's Degree or experience in a healthcare or health plan setting coding and auditing will also be considered. 2 years of experience with Facets Claims Adjudication system and/or Optum CES editing software. Remote Availability Providence Health Plan welcomes 100% remote work for applicants who reside in Washington, Oregon, or California. About Providence Providence is committed to a culture of patient-focused, whole-person care and values diversity, inclusion, and respect. We offer a comprehensive benefits package and opportunities for professional growth. Equal Opportunity Providence is an Equal Opportunity Employer. We are dedicated to creating an inclusive workplace and ensuring equal opportunities for advancement. #J-18808-Ljbffr Providence Health & Services

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