Gravie
Clinical
ClinicalOperationsAnalyst,MedicalCoding
Neural analysis suggests this role is
optimal for Mid candidates.
“Clinical Operations Analyst, Medical Coding at Gravie. Skills: health plan operations, clinical strategy, medical coding principles, coding & compliance, utilization & claims oversight, financial & risk management, data analytics. Support the design and implementation of clinical protocols, SOPs, and medical policies to guide the effective and accurate application of benefits.. Analyze medical records and plan design language to ensure accurate code assignments (ICD, CPT, HCPC) and maintain comp”
Industry & Context.
analyze data, identify trends, and support decision-making related to fraud, waste, and abuse; recommend corrective actions
What They're Looking For.
Must Have
Successful completion of a medical coding certification program., Bachelor’s degree in Nursing, Health Information Management, or a related education., 5+ years of medical coding experience, 2+ years in a health plan, TPA, or managed care organization., Expert knowledge of anatomy, medical terminology, and coding systems, Demonstrated ability to analyze data, identify trends, and support decision-making related to fraud, waste, and abuse, with the ability to exercise independent judgment.
Nice to Have
Previous experience at a high growth company.
What You'll Do.
Support the design and implementation of clinical protocols
and medical policies to guide the effective and accurate application of benefits.
Analyze medical records and plan design language to ensure accurate code assignments (ICD
HCPC) and maintain compliance with federal and state regulations
applying independent judgment in coding interpretation and compliance decisions.
Evaluate treatment plans
utilization management strategies
and prior authorizations while auditing large claims and itemized bills to identify discrepancies and recommend corrective actions.
Partner with underwriting and stop-loss teams by providing coding insights to assess risk profiles and evaluate potential financial exposure related to medical treatments.
Support clinical operations in the management
and oversight of clinical program data.
Act as a trusted advisor across the organization
providing guidance and training materials to internal staff regarding coding practices and clinical standards.
How You'll Work.
Team & Collaboration
Act as a trusted advisor across the organization, providing guidance and training materials to internal staff regarding coding practices and clinical standards.; Partner with underwriting and stop-loss teams
Communication Scope
providing guidance and training materials
Full Job Description
## Description Hi, we’re Gravie. Our mission is to create health benefits that actually benefit small and midsize businesses and their employees. Our innovative benefit solutions and services are developed and delivered by a diverse group of unique people. We encourage you to be your authentic self - we like you that way. A Little More About the Role: We are seeking an individual with deep expertise in health plan operations, clinical strategy, and medical coding principles. In this dual-impact role, you will bridge the gap between clinical terminology, and operational execution. You will play a crucial role in shaping our health plan’s policies and procedures, ensuring that medical procedures and diagnoses are accurately translated into appropriate codes while driving innovative cost-containment solutions. You Will: Policy & Protocol Development: Support the design and implementation of clinical protocols, SOPs, and medical policies to guide the effective and accurate application of benefits. Coding & Compliance: Analyze medical records and plan design language to ensure accurate code assignments (ICD, CPT, HCPC) and maintain compliance with federal and state regulations, applying independent judgment in coding interpretation and compliance decisions. Utilization & Claims Oversight: Evaluate treatment plans, utilization management strategies, and prior authorizations while auditing large claims and itemized bills to identify discrepancies and recommend corrective actions. Financial & Risk Management: Partner with underwriting and stop-loss teams by providing coding insights to assess risk profiles and evaluate potential financial exposure related to medical treatments. Data Analytics: Support clinical operations in the management, analysis, and oversight of clinical program data. Collaboration & Training: Act as a trusted advisor across the organization, providing guidance and training materials to internal staff regarding coding practices and clinical standards.
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