Certified Coding Analyst 

 

Of the $3.8T we spend on healthcare in the United States annually, about a third of it is estimated to be lost due to waste, fraud and abuse.  Codoxo is the premier provider of artificial intelligence-driven solutions and services that help healthcare companies and agencies proactively detect and reduce risks from fraud, waste, and abuse and ensure payment integrity. Codoxo helps clients manage costs across network management, clinical care, provider coding and billing, payment integrity, and special investigation units. Our software-as-a service applications are built on our proven Forensic AI Engine, which uses patented AI-based technology to identify problems and suspicious behavior far faster and earlier than traditional techniques.

 

We are venture backed by some of the top investors in the country, with strong financials, and remain one of the fastest growing healthcare AI companies in the industry. 


Position Summary: 

We are seeking a talented Certified Coding Analyst with prior experience in ensuring all claims billed are appropriately coded per coding standards and adheres to all rules and regulations. This position educates providers on their billing practices, internal staff on coding standards and assists in the claim review process. 

 

Key Responsibilities:

  • Identifies aberrant billing patterns and trends, evidence of fraud, waste or abuse, and recommends providers to be flagged for review 
  • Reviews and analyzes professional, facility/institutional and pharmacy claims and supporting documentation for Common Procedural Terminology (CPT), HCPCS Level II, Health Insurance Prospective Payment Systems (HIPPS), and International Classification of Diseases (ICD) code verification to include accuracy and completeness. 
  • Performs clinical coding review to ensure accuracy of medical coding and utilizes clinical expertise and judgment to determine correct coding & billing 
  • Makes coding determinations based on coding standards of practice and all applicable rules and regulations.  
  • Applies coding knowledge to assess and ensure services/items billed are reasonable and necessary, supported by national and local policies, are under accepted billing and coding practices, and meet standards of medical care. 
  • Extensive knowledge of federal, state, and payer-specific regulations and policies pertaining to coding, and billing, with demonstrated ability to interpret such guidelines 
  • Makes outbound and takes inbound calls to and from providers to answer any coding related questions they may have. 
  • Demonstrates commitment to continuous learning keeping current with evolving quality payment programs, risk-adjusted data requirements and emerging trends in provider reimbursement landscape. 
  • Provides clinical support and expertise to the other investigative and analytical areas 

 

Qualifications:

  • Experience in a cost containment, payment integrity or fraud, waste and abuse department
  • Associate degree in healthcare-related field OR equivalent work experience 
  • Analytical skills related to coding across multiple providers
  • 3 years' experience in healthcare billing 
  • CPC, COC, CIC, or other AAPC designated credential 
  • Demonstrated knowledge of CPT, HCPCS, and ICD-10 rules and regulations 
  • Experience with provider communication and education
  • Excellent written and verbal communication skills
  • Physical Requirements: Work is performed in an office environment (either in our office or work-from home) and requires the ability to work on a computer, operate standard office equipment, and work at a desk. 

 

 

Preferred Qualifications: 

  • Bachelor's degree in healthcare-related field OR equivalent work experience 
  • 5 years' experience in a professional, institutional and pharmacy billing
  •  Coding experience in multiple specialties 
  • Experience in multiple software platforms and/or ability to query large data sets
  • Multiple coding certifications (CPC, CIC, COC etc.) 

 

Accessibility Notice: If you need reasonable accommodation for any part of the employment process due to a physical or mental disability, please send and email to careers@codoxo.com with the subject "Accommodation". Reasonable accommodation requests will be considered on a case-by-case ba

 

Benefits for You

Health, Dental, and Vision insurance with 100% employee premium coverage (Starts Day 1)

Unlimited PTO

Annual Professional Development stipend

Annual home office stipend

401K Match (after 90 days)

 

We are an Equal Opportunity Employer:

Codoxo provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.  This policy applies to all terms and conditions of employment.