VendorMedicalCodingAnalyst

## Accountabilities In this role, you will analyze medical records, coding practices, and vendor claims data to ensure accuracy, compliance, and alignment with established reimbursement and coding guidelines. Review and audit medical documentation to validate diagnosis and procedure coding accuracy in vendor-submitted claims Identify root causes of payment discrepancies and lead resolution efforts with vendors and internal stakeholders Conduct medical record audits and assess claims impact to support accurate reimbursement outcomes Develop and implement process improvement initiatives to address coding, billing, and operational gaps Serve as a subject matter expert on coding guidelines, reimbursement methodologies, and claims interpretation Create test scenarios and validation plans to ensure compliance with industry coding standards Track issue resolution progress and ensure timely completion of corrective actions across teams Collaborate cross-functionally to support regulatory compliance and vendor performance management Requirements This role requires strong expertise in medical coding, claims processing, and healthcare reimbursement systems, combined with analytical and communication skills to influence outcomes across teams and vendors. Bachelor’s degree or equivalent relevant experience in lieu of degree Certified Medical Coder (CPC, RHIT, or RHIA) required Minimum 3 years of medical billing and coding experience At least 3 years of claims payment or claims processing experience Managed care experience preferred Strong knowledge of ICD, CPT coding guidelines, medical terminology, and anatomy/physiology Understanding of Medicare, Medicaid, and commercial reimbursement methodologies (APC, DRG, OPPS preferred) Proficiency with claims systems and tools such as Facets, along with Microsoft Office applications Strong analytical thinking, attention to detail, and ability to identify trends in complex data Excellent written and verbal communication skills with the ab