Claims Coding Analyst Senior

Job Duties

HealthPartners is hiring a Senior Claims Coding Analyst. The Senior Coding Analyst provides advanced expertise in coding compliance, claims adjudication accuracy, and coding system governance. This role ensures the claims processing system accurately reflects industry-standard coding requirements including CPT, HCPCS, ICD-9, ICD-10, and related code sets to maintain regulatory compliance. The Senior Analyst supports evaluation of new codes, regulatory updates, and plan-specific policies, while investigating complex claims to determine reimbursement accuracy and identify provider billing trends and errors. This position also leads coding system enhancements, supports integration of vendor editing solutions, and drives revenue optimization through coding accuracy and system configuration.

MINIMUM QUALIFICATIONS:

Education, Experience or Equivalent Combination:

Expert-level completion of Medical Coding Program with certification (AAPC or AHIMA equivalent: CPC, CCA, CCS)

Minimum 5 years of coding experience across multiple patient visit types

Minimum 5 years experience working with HMO, fully insured, indemnity, and government programs

Prior experience in medical claims processing and adjudication

Experience using coding software platforms and system editing tools

Demonstrated ability to independently analyze and adjudicate complex claims scenarios

Licensure/ Registration/ Certification:

CPC, CCA, CCS or equivalent (required)

Knowledge, Skills, and Abilities:

Advanced knowledge of CPT, HCPCS, ICD-10, revenue codes, and claim formats (837P/837I)

Strong understanding of anatomy, physiology, disease processes, and medical billing practices

Knowledge of COB rules including Medicare regulations

Experience with vendor coding software, claims processing systems, and encoder tools

Strong analytical, trend analysis, and problem-solving capabilities

Ability to make independent decisions and complex judgment calls

Strong organizational, planning, and prioritization skills

Proficient in Microsoft tools and data analysis

Effective communication skills across technical and business stakeholders

PREFERRED QUALIFICATIONS:

Education, Experience or Equivalent Combination:

Bachelor's degree in a related field

7+ years of experience in the healthcare industry

Licensure/ Registration/ Certification:

Advanced or specialty coding certifications preferred

Knowledge, Skills, and Abilities:

Deep familiarity with coding governance, audit processes, and reimbursement methodologies

Experience supporting policy development and coding compliance initiatives

ESSENTIAL DUTIES:

(25%) Advanced Coding Compliance & Claims Adjudication

Review complex claims for coding accuracy, medical appropriateness, and reimbursement integrity

Approve or deny claims based on coding guidelines and policy requirements

Resolve claim processing errors related to code validation during adjudication

Ensure compliance with HIPAA and industry coding standards across all claim types

(20%) Coding System Governance & Optimization

Administer, maintain, and audit coding systems and vendor editing software

Support implementation of new, revised, and deleted code sets including CPT pairs

Lead testing, validation, and deployment of coding system updates

Ensure system configurations align with regulatory,business requirements, and current coding requirements

(20%) Analysis, Trend Identification & Revenue Optimization

Perform trend analysis to identify billing patterns, reimbursement impacts, and revenue opportunities

Evaluate coding edits and business rules to ensure optimal system performance

Identify opportunities to reduce claim inventory and improve financial outcomes

Support data-driven decision making through analytics and reporting

(15%) Stakeholder Leadership & Cross-functional Support

Serve as subject matter expert for coding across Claims, Sales, Contracting, and other departments

Represent the organization in internal committees and external industry forums

Support policy development with Medical Policy, Government Programs, and compliance teams

Communicate coding outcomes and provide guidance on complex issues

(10%) Vendor & System Integration Management

Serve as primary contact for coding software vendors

Collaborate with Business Systems Analysts and IT to design and implement system enhancements

Support integration and optimization of coding software within claims platforms

(10%) Training, Mentorship & Documentation

Provide training, mentorship, and work direction to team members

Maintain accurate documentation of coding policies, procedures, and system changes

Ensure audit readiness through comprehensive recordkeeping of coding updates

We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.

Minimum Education Required

Bachelor Degree

Minimum Experience Required

5 - 20 years

Shift

First (Day)

Number of Openings

1

Public Transportation Accessible

Yes

Veterans Encouraged to Apply

No

Physical Required

Yes

Drug Test Required

Yes

Compensation

$33.29 - $49.93 / Hourly

Postal Code

55420

Job Type

Full Time

Place of Work

On-site

Requisition ID

123209

Job Benefits

Not specified