Clinical Operations Analyst, Medical CodingGravie • Saint Paul, Illinois, United States
Clinical Operations Analyst, Medical Coding
Gravie
- Saint Paul, Illinois, United States
- Saint Paul, Illinois, United States
Über
You Will
Policy & Protocol Development: Support the design and implementation of clinical protocols, SOPs, and medical policies to guide the effective and accurate application of benefits.
Coding & Compliance: Analyze medical records and plan design language to ensure accurate code assignments (ICD, CPT, HCPC) and maintain compliance with federal and state regulations, applying independent judgment in coding interpretation and compliance decisions.
Utilization & Claims Oversight: Evaluate treatment plans, utilization management strategies, and prior authorizations while auditing large claims and itemized bills to identify discrepancies and recommend corrective actions.
Financial & Risk Management: Partner with underwriting and stop-loss teams by providing coding insights to assess risk profiles and evaluate potential financial exposure related to medical treatments.
Data Analytics: Support clinical operations in the management, analysis, and oversight of clinical program data.
Collaboration & Training: Act as a trusted advisor across the organization, providing guidance and training materials to internal staff regarding coding practices and clinical standards.
You Bring
Successful completion of a medical coding certification program.
Bachelor’s degree in Nursing, Health Information Management, or a related education.
5+ years of medical coding experience and 2+ years in a health plan, TPA, or managed care organization.
Expert knowledge of anatomy, medical terminology, and coding systems, including experience with coding software and EHRs.
Demonstrated ability to analyze data, identify trends, and support decision-making related to fraud, waste, and abuse, with the ability to exercise independent judgment.
Extra credit Previous experience at a high growth company.
Benefits The salary range for this position is $71,775 - $95,700 annually. Numerous factors including, but not limited to, education, skills, work experience, certifications, etc. will be considered when determining compensation.
Our unique benefits program is the gravy, i.e., the special sauce that sets our compensation package apart. In addition to standard health and wellness benefits, Gravie’s package includes alternative medicine coverage, generous PTO, up to 16 weeks paid parental leave, paid holidays, a 401k program, transportation perks, education reimbursement, and paid paw-ternity leave.
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Sprachkenntnisse
- English
Hinweis für Nutzer
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