Coding Business Analyst II - Content Updates
Core
Analyze and interpret coding, reimbursement, and regulatory guidelines to ensure organizational compliance and payment integrity for a national health organization.
Role type
Business Analyst (Healthcare Claims & Coding)
Builds
Payment policies, reimbursement methodologies, and claims editing logic
Domain
Healthcare / Managed Care / Insurance
Deliverable
production ML models | product features | dashboards & analysis | client delivery | infrastructure | physical/clinical work
Required skills
Business process analysis, Claims payment analysis, Regulatory guideline interpretation, Data analysis, User acceptance testing, Requirements gathering, Process improvement, Policy development, Stakeholder coordination, Operational reporting
Preferred skills
CPC certification, Claims coding appeals and auditing, Claims research, Managed care information systems knowledge, Benefits pricing and contracting knowledge, Provider reimbursement methodologies knowledge, Structured testing experience, Excel (pivot tables, VLOOKUPs)
Technologies
Excel
Responsibilities
Ensure internal claims coding editors remain accurate, up to date, and compliant; Develop and maintain Payment Policies and claims editing logic; Monitor and track regulatory updates; Support business initiatives through data analysis and UAT; Identify user requirements to improve processes; Lead problem solving and coordination between business units; Assist in formulating departmental policies.
Seniority
Mid-level, hands-on IC