Coding Analyst II

Medica is a nonprofit health plan serving members and communities across multiple states. The Coding Analyst II performs medical coding, audits, and analysis to support accurate claims processing, reimbursement, compliance, and data integrity, while providing coding expertise to internal partners and guidance to junior analysts.

Responsibilities

• Review and code clinical documentation using ICD, CPT, HCPCS, and internal coding guidelines
• Validate coding accuracy to support compliant billing, reimbursement, and data reporting
• Research missing or unclear information to ensure proper code assignment
• Complete timely coding reviews that enable accurate claims processing
• Perform audits of claims, encounters, and documentation to detect coding errors or inconsistencies
• Analyze coding patterns to identify trends, risks, or gaps affecting payment accuracy
• Document findings clearly and recommend corrective actions that reduce recurrence
• Communicate audit results to internal partners, ensuring clarity, professionalism, and follow-through
• Investigate coding impacts on claims adjudication, reimbursement, and provider disputes
• Collaborate with configuration, operations, and provider teams to resolve issues efficiently
• Verify coding rules within system logic and flag discrepancies for correction
• Support issue triage workflows that improve operational stability and payment accuracy
• Apply coding regulations, payer guidelines, and organizational policies consistently
• Maintain compliance with regulatory requirements, audit standards, and documentation expectations
• Participate in coding quality initiatives that strengthen accuracy and reduce rework
• Monitor updates to coding rules and support implementation of required changes
• Provide guidance to junior analysts on coding practices, documentation requirements, and audit methods
• Assist with training, documentation updates, and knowledge-sharing within the team
• Participate in process improvement efforts that enhance coding workflows and accuracy
• Contribute to team goals by delivering reliable expertise, consistent quality, and timely work
• Performs other duties as assigned

Preferred

• Demonstrated knowledge of revenue codes, National Uniform Billing Committee (NUBC) guidelines, UB-04 claim requirements, DRGs, and facility reimbursement methodologies
• Experience analyzing medical coding and claim data to determine appropriate coding, payment, and reimbursement outcomes
• Strong understanding of how coding impacts claim adjudication, provider reimbursement, and payment accuracy
• Experience researching and interpreting coding guidelines, industry standards, and healthcare billing requirements
• Proven analytical and problem-solving skills with the ability to investigate coding issues and identify root causes
• Ability to track trends, identify process improvement opportunities, and recommend upstream solutions to reduce rework and adjustments
• Strong written and verbal communication skills with the ability to explain coding decisions and rationale to internal stakeholders
• Revenue Codes
• NUBC Guidelines
• UB-04 Claims
• DRGs
• Facility Reimbursement
• Claims Data Analysis
• Coding
• Payment Analysis
• Reimbursement Outcomes
• Claim Adjudication
• Payment Accuracy
• Coding Guidelines
• Industry Standards
• Healthcare Billing Requirements
• Coding Issue Investigation
• Root Cause Analysis
• Trend Analysis
• Process Improvement
• Upstream Solutions
• Rework Reduction
• Adjustment Reduction
• Analytical Skills
• Problem-Solving
• Written Communication
• Verbal Communication
• Explaining Decisions

Benefits

• Competitive medical, dental, vision
• PTO
• Holidays
• Paid volunteer time off
• 401K contributions
• Caregiver services

Company

• Nonprofit health insurer offering individual, employer, Medicaid, and Medicare plans
• Minnetonka, Minnesota, USA
• https://www.medica.com/
• Founded in 1975
• 1001-5000 employees

Qualifications

• Bachelor's degree in Health Information Management, Healthcare Administration, Business, or a related field, or equivalent combination of education and experience
• 3+ years of work experience beyond degree in coding for health plan, insurance payer, facility and/or hospital
• Coding certification required (CCA, CPC-P, CPC, CPC-H, CCS, CCS-P, RHIT, RHIA)
• All candidates must be legally authorized to work in the United States at the time of application
• Demonstrated knowledge of revenue codes, National Uniform Billing Committee (NUBC) guidelines, UB-04 claim requirements, DRGs, and facility reimbursement methodologies
• Experience analyzing medical coding and claim data to determine appropriate coding, payment, and reimbursement outcomes
• Strong understanding of how coding impacts claim adjudication, provider reimbursement, and payment accuracy
• Experience researching and interpreting coding guidelines, industry standards, and healthcare billing requirements
• Proven analytical and problem-solving skills with the ability to investigate coding issues and identify root causes
• Ability to track trends, identify process improvement opportunities, and recommend upstream solutions to reduce rework and adjustments
• Strong written and verbal communication skills with the ability to explain coding decisions and rationale to internal stakeholders

Required skills

• CPT, Claims Auditing, Coding Certification, Coding Certification CCA, Coding Certification CCS, Coding Certification CCS-P, Coding Certification CPC, Coding Certification CPC-H, Coding Certification CPC-P, Coding Certification RHIA, Coding Certification RHIT, DRGs, Facility Reimbursement Methodologies, HCPCS, Healthcare Billing Requirements, ICD, Medical Coding, NUBC Guidelines, Revenue Codes, UB-04 Claim Requirements

Preferred skills

• Written and Verbal Communication

Experience

• 3+ years