Coding Business Analyst II - Repository Updates
Core
Analyze and update payment integrity repositories, interpret coding and reimbursement guidelines, and develop claims editing logic to ensure accurate claims adjudication for a national health organization.
Role type
Business Analyst (Healthcare Claims & Payment Integrity)
Builds
Payment policies, reimbursement methodologies, and claims editing logic
Domain
Healthcare / Managed Care / Claims Processing
Deliverable
production ML models | product features | dashboards & analysis | client delivery | infrastructure | physical/clinical work
Required skills
Business process analysis, regulatory compliance analysis, data analysis, user requirement identification, UAT support, process improvement, policy development, stakeholder coordination
Preferred skills
CPC certification, claims coding research, claims research, Excel (pivot tables, VLOOKUP), Smartsheet, managed care systems knowledge, benefits/contracting knowledge
Technologies
Smartsheet, Excel
Responsibilities
Review and interpret coding and reimbursement guidelines, develop and maintain payment policies and claims editing logic, monitor regulatory updates, support business initiatives through data analysis and UAT, identify process improvements, lead problem-solving between business units
Seniority
Mid-level, hands-on IC