About the Role
The Coding Policy Analyst is responsible for updating and maintaining coding policies and associated edit configurations within Providence Health Plan’s claims editing system. This role responds to provider and member appeals with proper coding rationale and monitors coding changes from agencies like AMA, CMS, Medicaid, and specialty societies to ensure compliant implementation within claims adjudication software.
Key Responsibilities
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Update and create coding policies and edit configurations for PHP claims editing system
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Respond to provider and member appeals with accurate CPT, CMS, and coding policy rationale
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Monitor and implement coding changes and guidelines from AMA, CMS, Medicaid, and other external bodies
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Collaborate with internal teams to ensure coding compliance and efficient claims processing
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Maintain documentation of coding policies and edits
Required Qualifications
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Coding certification through AAPC (CPC) or AHIMA (CCS) upon hire
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Minimum 5 years CPT coding experience in a healthcare provider, insurer, or managed care environment
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Strong writing and grammar skills with 5 years’ experience
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Proficiency with Microsoft Office applications (Excel, Word, Access)
Preferred Qualifications
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Bachelor’s degree or healthcare/health plan experience in coding/auditing
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2 years experience with Facets Claims Adjudication system and/or Optum CES editing software
Compensation
Salary varies by location within WA, OR, CA, with a base pay range approximately $28.21 – $57.56/hour depending on geography and experience.
Why Join Providence Health Plan?
Providence offers competitive benefits including healthcare, retirement plans with employer match, paid parental leave, and professional growth opportunities. Join a patient-focused organization committed to diversity, inclusion, and empowering employees.
Equal Opportunity Employer
Providence is committed to a discrimination-free workplace and values diversity across all levels.