Claims Coding Analyst

Job Duties

HealthPartners is hiring a Claims Coding Analyst. They provide expert support in medical coding compliance, claims adjudication accuracy, and coding system integrity. This role ensures that claims processing systems accurately reflect industry-standard coding requirements including CPT, HCPCS, ICD-9, ICD-10, and related code sets. The analyst supports implementation of regulatory and policy changes, evaluates coding-related claim issues, and identifies billing trends and errors. The position partners with internal stakeholders and external vendors to maintain coding system functionality and ensure accurate reimbursement and compliance outcomes.

MINIMUM QUALIFICATIONS:

Education, Experience or Equivalent Combination:

Completion of Medical Coding Program with certification (AAPC or AHIMA equivalent: CPC, CCA, CCS), or ability to obtain within one year

Minimum 2 years of coding experience across multiple patient visit types

Experience in claims processing and medical billing within healthcare or insurance settings

Experience with HMO, fully insured, indemnity, and government programs

Demonstrated ability to make independent decisions in claim coding and adjudication

Licensure/ Registration/ Certification:

CPC, CCA, CCS or equivalent (required or obtained within one year from date of hire)

Knowledge, Skills, and Abilities:

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

Understanding of medical terminology, anatomy, physiology, and disease processes

Knowledge of Coordination of Benefits (COB) rules, including Medicare regulations

Experience using claims processing systems, encoder tools, and coding software

Strong analytical, problem-solving, and trend analysis skills

Solid organizational and planning capabilities

Proficient in Microsoft tools and data analysis

Ability to communicate effectively with internal stakeholders and external parties

PREFERRED QUALIFICATIONS:

Education, Experience or Equivalent Combination:

Bachelor's degree in a related field

5+ years of experience in the healthcare industry

Licensure/ Registration/ Certification:

Advanced or specialty coding certifications preferred

Knowledge, Skills, and Abilities:

Experience with claims processing systems

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

ESSENTIAL DUTIES:

(50%) Coding Compliance & Claims Adjudication

Review and evaluate claims for coding accuracy and medical appropriateness

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 Management & Updates

Monitor CMS, NUBC, and other regulatory bodies for coding updates

Support implementation, testing, and validation of coding system updates

Maintain and support coding systems including vendor-managed platforms (e.g., ClaimCheck)

Ensure system configuration aligns with current coding requirements

(20%) Analysis, Research & Trend Identification

Analyze coding-related claim issues to identify billing trends, errors, and opportunities

Recommend enhancements or corrections for identified billing trends, errors, and opportunities

Conduct research to support new code implementation or policy changes

Evaluate coding business rules and recommend enhancements or corrections

Perform trend analysis to support business decision-making

(10%) Stakeholder Support & Communication

Serve as subject matter expert for coding questions across the organization

Act as key point of contact for claims, provider appeals, and adjustment requests

Communicate coding review outcomes to members and providers when appropriate

Support cross-functional teams including claims, sales, and contracting

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

1 - 2 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

$29.57 - $44.35 / Hourly

Postal Code

55420

Job Type

Full Time

Place of Work

On-site

Requisition ID

124470

Job Benefits

Not specified