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Clinical Analyst, Coding Specialist
Sunshine Enterprise USAClinical Analyst & Coding Specialist supporting ongoing Medicaid operations and healthcare system initiatives. Collaborating with business and technical teams for coding updates and policy implementation.
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates extensive expertise in ICD-10, CPT, and HCPCS coding methodologies, along with strong analytical skills to assess coding changes and their operational impacts. Proven ability to collaborate with stakeholders and technical teams to implement coding updates and maintain comprehensive documentation.
Highest-signal resume keywords
ICD-10 Coding MethodologyCPT Coding MethodologyHCPCS Coding MethodologyStakeholder ManagementBusiness Requirements Gathering
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Medical CodingHealthcare InsuranceProgram IntegrityClinical ExperienceAnatomy KnowledgePhysiology KnowledgePharmacology KnowledgeMedical TerminologyBusiness Process DocumentationAnalytical Skills
Soft Skills
Communication SkillsCollaboration Skills
Industry Keywords
Payer EnvironmentHealthcare Systems ModernizationMedical ReviewICD-10 UpdatesCPT UpdatesHCPCS Updates
About the role
Key responsibilities & impact- Coordinate annual and quarterly ICD-10, CPT, and HCPCS code updates.
- Review and analyze coding changes to determine business and operational impacts.
- Prepare code change documentation for stakeholder review.
- Collaborate with business users, stakeholders, and technical teams to implement coding and policy updates.
- Participate in meetings related to healthcare systems modernization initiatives.
- Serve as a Subject Matter Expert (SME) for medical coding methodologies and Medicaid-related processes.
- Research business rules, requirements, and workflows to develop recommendations.
- Maintain business rules, process documentation, and requirements repositories.
- Support process documentation, knowledge transfer, and training activities.
- Review medical records against established criteria to determine medical necessity when required.
- Assist with additional healthcare and project-related initiatives.
Requirements
What you’ll need- 10+ years of experience in healthcare insurance, medical review, program integrity, or appeals.
- 5+ years working with IT developers/programmers in a payer environment.
- 5+ years of medical coding experience in a payer environment.
- 3+ years of clinical experience in a healthcare environment.
- Strong knowledge of ICD-10, CPT, and HCPCS coding methodologies.
- Strong knowledge of anatomy, physiology, pharmacology, and medical terminology.
- Experience gathering business requirements and documenting business processes.
- Excellent analytical, communication, and stakeholder management skills.
Benefits
Comp & perks- Hybrid (80% remote, onsite for required trainings and meetings)