HealthPartners

The Payment Integrity Coding Analyst provides 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

At HealthPartners we believe in the power of good – good deeds and good people working together. As part of our team, you’ll find an inclusive environment that encourages new ways of thinking, celebrates differences, and recognizes hard work.

We’re a nonprofit, integrated health care organization, providing health insurance in six states and high-quality care at more than 90 locations, including hospitals and clinics in Minnesota and Wisconsin. We bring together research and education through HealthPartners Institute, training medical professionals across the region and conducting innovative research that improve lives around the world.

At HealthPartners, everyone is welcome, included and valued. We’re working together to increase diversity and inclusion in our workplace, advance health equity in care and coverage, and partner with the community as advocates for change.

Benefits Designed to Support Your Total Health

As a HealthPartners colleague, we’re committed to nurturing your diverse talents, valuing your dedication, and supporting your work-life balance. We offer a comprehensive range of benefits to support every aspect of your life, including health, time off, retirement planning, and continuous learning opportunities. Our goal is to help you thrive physically, mentally, emotionally, and financially, so you can continue delivering exceptional care.

Join us in our mission to improve the health and well-being of our patients, members, and communities.

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