Vendor Medical Coding Analyst

CareSource

Medical Coding Analyst ensuring accuracy in vendor payment process through coding analysis by auditing medical records. Leading root cause identification for claims issues and implementing process improvements.

Posted 5/6/2026full-timeRemote • 🇺🇸 United StatesMid-LevelSenior💰 $54,500 - $87,300 per yearWebsite

About the role

Key responsibilities & impact

Analyze medical records and supplemental data to ensure diagnostic and procedural codes accurately reflect and support the visit as it relates to correct coding guidelines and medical necessity
Lead the identification of root causes of claims issues
Hold vendors and internal CareSource teams accountable in implementing process improvements
Audit and interpret medical procedures and terminology in medical documentation
Utilize critical thinking skills, discretion and independent judgment to determine best course of action for each inquiry
Identify root cause of vendor payment issues
Lead solutioning sessions with vendor and internal CareSource teams
Conduct audits of vendor medical records
Assess and generate reports to determine claim impact to aid in resolution
Collaborate with leadership to advocate resolving issues based on industry standard coding practices
Act as a subject matter expert to analyze and decide the appropriate reimbursement for codes submitted on claims
Track status and oversee the work to conclusion as it moves through vendor and internal teams
Develop claims test case scenarios and test plans to ensure industry standard coding practices are implemented
Conduct on-going monitoring and communications to promote and ensure adherence to established protocols and best practices
Build and maintain cross-functional working relationships with operational departments, markets, and Quality leaders
Maintain an understanding of Federal and State Regulatory requirements
Interface with vendor and represent CareSource in a professional manner
Assist the vendors proactively by evaluating risks and developing risk-mitigation actions

Requirements

What you’ll need

Bachelor's degree required
Equivalent years of relevant work experience may be accepted in lieu of required education
Three (3) years Medical billing coding experience required
Three (3) years Managed Care experience preferred
Three (3) years of claims payment experience required
Knowledge of diagnosis codes, and CPT coding guidelines; medical terminology; anatomy and physiology; and Medicare/Medicaid/Commercial reimbursement guidelines
Intermediate level of Facets, Microsoft Word, Excel, PowerPoint and Access
Firm understanding of basic medical billing process
Reimbursement Methodology (APC, DRG, OPPS) preferred
Advanced communication skills
Data analysis and quality assurance skills
Ability to work independently and within a team environment
Ability to generate reports & identify trends in coding
Attention to detail
Familiarity of the healthcare field
Knowledge of Medicaid/Medicare/Commercial
Critical listening and thinking skills
Claims processing skills
Technical writing skills
Time management skills
Decision making/problem solving skills
Certified Medical Coder (CPC, RHIT or RHIA) required

Benefits

Comp & perks

bonuses tied to company and individual performance
comprehensive total rewards package

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

medical billing codingclaims paymentdiagnosis codesCPT coding guidelinesmedical terminologyanatomy and physiologyMedicare reimbursement guidelinesMedicaid reimbursement guidelinesCommercial reimbursement guidelinesReimbursement Methodology

Soft Skills

advanced communication skillsdata analysis skillsquality assurance skillsattention to detailcritical listening skillscritical thinking skillsdecision making skillsproblem solving skillstime management skillsability to work independently

Certifications

Certified Medical CoderCPCRHITRHIA