Job Description

Overview Coding Policy Analyst (Remote) at Health Plan. The Coding Policy Analyst coordinates technically detailed work that impacts operations and information systems within Providence Health Plan (PHP). This role updates and creates Coding Policies and associated edit configurations within the PHP claims editing system. The analyst also responds to provider and member appeals and provides the appropriate CPT, CMS, specialty society, Coding Policy, or other official documentation rationale for Coding Policy edits. The analyst monitors changes to codes, coding guidelines and regulations, and coding edits from external agencies (e.g., AMA, CMS, Medicaid, specialty societies) and assists with implementing such changes to the claims adjudication and editing software. Providence Health Plan emphasizes patient-focused, whole-person care and values diverse, inclusive teams. Providence supports 100% remote work for applicants in eligible states. Responsibilities Coordinate technically detailed work that affects PHP operations and information systems. Update and create Coding Policies and edit configurations within the PHP claims editing system. Reply to provider and member appeals with CPT, CMS, specialty society, Coding Policy, and other official rationale for edits. Monitor changes to codes, coding guidelines, and regulations from external agencies and assist with implementation into claims adjudication/editing software. Qualifications Required: Coding certification through AAPC (CPC) or AHIMA (CCS) upon hire. Experience: 5 years of CPT coding experience from chart extraction with a health care provider, health insurance company, or capitated managed care company. Communication: 5 years of excellent writing and grammar skills. Technical: 5 years of experience in detailed coding applications and proficiency in Microsoft Office (Excel, Word, Access). Preferred Qualifications Bachelor's Degree or experience in a Healthcare or Health Plan setting coding/auditing. 2 years of experience with Facets Claims Adjudication system and/or Optum CES editing software. Location and Compensation Remote; Providence accepts applications from eligible states (Washington, Oregon, California). The salary range is listed by location and may include additional compensation such as shift differentials or bonuses. About Providence Providence is committed to an inclusive workplace where diversity is valued and everyone is essential, heard, and respected. Our 120,000 caregivers serve in over 50 hospitals and 1,000+ clinics across several states, delivering comprehensive health and social services. Providence is an Equal Opportunity Employer. We do not discriminate on the basis of race, color, gender, disability, veteran status, religion, age, national origin, sexual orientation or any other basis prohibited by law. Requisition ID: 383518 #J-18808-Ljbffr Providence

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