Source Job

$57,111–$98,993/yr
US 3w PTO

  • Identify and manage changes to medical rules by reviewing policies, transmittals, and bulletins for revision, retirement, or addition.
  • Build and maintain Clinical Transaction Engine tables, assign CPT/HCPCS codes, and review national policies for integration into medical edits.
  • Independently prepare data editorials for production release, analyze coding trends, and resolve client issues forwarded by Compliance Support.

CPT Coding Medical Terminology

20 jobs similar to Senior Managed Care Policy Analyst

Jobs ranked by similarity.

US

  • Review and validate medical codes for accuracy and compliance.
  • Provide expert coding guidance and support to clinicians.
  • Conduct coding audits and quality reviews to ensure adherence to regulatory guidelines.

Mission Healthcare is the largest home health and hospice company in the western United States, located in seven states. They provide comprehensive services to meet the needs of patients and families, delivering care with Compassion, Accountability, Respect, Excellence, and Service (CARES).

US

  • Accurately assigning ICD-10, CPT, HCPCS, ASA, and modifiers for infusion services.
  • Reviewing medical documentation to ensure proper coding and compliance.
  • Staying up to date with third-party payer regulations and compliance guidelines.

IVX Health is a national provider of infusion and injection therapy for individuals managing chronic conditions. They are committed to exceptional care and empower their team to thrive while living their core values.

US

  • Responsible for coding and abstracting patient records for professional billing and reimbursement.
  • Reviews medical records retrospectively and concurrently for accurate diagnosis and procedure coding.
  • Serves as a resource for coding questions, assists with insurance denials, and makes process improvement recommendations.

Trinity Health is a not-for-profit, faith-based healthcare system providing diverse medical services across 27 states. With 121,000 colleagues and nearly 36,500 physicians, it operates 101 hospitals and numerous care locations, emphasizing compassionate, person-centered care and significant community investment.

US

  • Supports coding and documentation quality assurance.
  • Performs internal audits to assess compliance and quality.
  • Researches coding, billing, and charging compliance issues.

Presbyterian Healthcare Services is dedicated to improving the health of patients, members, and communities. They are a locally owned, not-for-profit healthcare system with nine hospitals, a statewide health plan, and a growing multi-specialty medical group, employing nearly 14,000 individuals.

US

  • Accurately abstracts information from service documentation and assigns CPT, ICD-10, and HCPCS codes for billing compliance.
  • Reviews and resolves coding denials and completes charge sessions in assigned work queues in a timely manner.
  • Ensures documentation meets current EM Guidelines and specific payer rules before releasing codes for billing.

UofL Health is a fully integrated regional academic health system with hospitals, medical centers, and numerous physician practice locations. It has over 14,000 team members, including physicians and nurses, focused on delivering patient-centered care.

US

  • Verify and analyze medical record documentation to assign diagnostic and procedural codes using CMS and organizational guidelines.
  • Serve as a resource for physicians and billing staff, resolving coding discrepancies and ensuring a 95% accuracy rate for charge entry.
  • Assist in training new employees and collaborate with the central billing office to process charges within two business days.

Munson Healthcare is northern Michigan's largest healthcare system, operating eight community hospitals to serve over half a million residents across 29 counties. The organization emphasizes a values-driven team culture focused on excellence, teamwork, and positivity in a region known for its natural beauty and outdoor lifestyle.

$70,000–$82,500/yr
US

  • Lead advanced coding education for individual providers and large provider groups, utilizing remote methods such as E/M and Medicare Preventive services.
  • Design, implement, and lead specialty-specific documentation and coding training programs to address unique needs and challenges.
  • Monitor market trends and emerging issues related to documentation and coding, ensuring timely and relevant updates to training programs.

Privia Health is a technology-driven, national physician enablement company that collaborates with medical groups, health plans, and health systems. They optimize physician practices, improve patient experiences, and reward doctors for delivering high-value care. Their platform is led by top industry talent and consists of scalable operations and end-to-end, cloud-based technology.

US

  • Codes complex inpatient acute care discharges using ICD-10-CM and ICD-10-PCS codes.
  • Reviews provider notes and clinical documentation to assign accurate codes.
  • Collaborates with CDI on discharges, regulatory guidelines, and coding conventions.

Hudson Regional Health is a newly unified healthcare network serving Hudson County through four hospitals. They deliver modern, patient-first care supported by innovation with state-of-the-art procedures and nationally recognized specialists, all within a connected, local network designed to put care first.

US

  • Assigns ICD-10-CM/PCS codes and assigns DRGs for inpatient medical records accounts; assigns ICD-10-CM/PCS codes and CPT codes for outpatient medical record accounts
  • Abstracts key data elements required for billing
  • Interacts with providers for clarification of documentation/education

UChicago Medicine has been at the forefront of medicine since 1899 and provides superior healthcare with compassion, always mindful that each patient is a person, an individual. To accomplish this, they need employees with passion, talent and commitment… with patients and with each other.

$53,926–$92,228/hr
US

  • Codes and abstracts hospital medical records for diagnostic and procedural coding.
  • Utilizes federal, state procedures/guidelines to assure accuracy of coding.
  • Collaborates with medical staff and clinical documentation improvement (CDI) staff to clarify documentation.

Virtua Health is dedicated to offering quality care through its extensive range of services and facilities. They have over 14,000 colleagues, including over 2,850 doctors, physician assistants, and nurse practitioners committed to providing quality healthcare.

US

  • Review and accurately code cases to maximize reimbursement in a timely manner.
  • Meet daily production goals and maintain a 95% accuracy rate.
  • Stay current on coding guidelines and maintain necessary credentials.

M&D Capital is a leading third-party Medical Billing and Revenue Cycle Management company serving clients across the United States. They operate offices across multiple states, along with a growing international team and specialize in out-of-network surgical claims, partnering directly with their clients to ensure the maximum reimbursement for their services.

US

  • Responsible for managing and overseeing activities for multiple value streams within the revenue cycle.
  • Provide ongoing input in the strategic planning of business requirements and corporate objectives for the Revenue Cycle.
  • Ensure compliance with all federal, state, and local statutes and regulations, as well as all third-party payer policies.

Virginia Mason Franciscan Health brings together two award-winning health systems in Washington state - CHI Franciscan and Virginia Mason. As one integrated health system, our team includes 18,000 staff and nearly 5,000 employed physicians and affiliated providers at 11 hospitals and nearly 300 sites throughout the greater Puget Sound region.

$26–$39/hr
US

  • Accurately translate patients’ medical records into standardized codes for diagnoses and treatments.
  • Ensure compliance with legal, regulatory, and organizational standards.
  • Ensure claims are processed correctly and on time.

Dignity Health Medical Foundation was established in 1993, and it is a California nonprofit public benefit corporation with care centers throughout California. Dignity Health Medical Foundation works together with physicians and providers throughout California to provide comprehensive health care services.

US 3w PTO

  • Assist Revenue Cycle Consultant and Technical Consultant teams in the implementation of Experian's Claim Source revenue cycle management system.
  • Review internal process, recommend and develop changes to improve systems efficiency, automation, and effectiveness.
  • Document complex solutions to internal and external clients.

Experian is a global data and technology company, powering opportunities for people and businesses around the world. They operate across a range of markets, from financial services to healthcare, automotive, agrifinance, insurance, and many more industry segments, with corporate headquarters in Dublin, Ireland, and a team of 23,300 people across 32 countries.

US

  • Maintains the practice management system by entering accurate data, verifying and updating insurance and claims information.
  • Prepares, reviews, submits, and follows up with clean claims to various companies/individuals.
  • Collects, posts, and manages patient account payments.

US Anesthesia Partners provides anesthesia services. They are an equal opportunity employer and value diversity.

  • Review documents to identify all procedures and diagnosis.
  • Ensure the encounters have been coded correctly based on documents received.
  • Ensure encounters are coded using the most current coding guidelines.

Ventra is a business solutions provider for facility-based physicians practicing anesthesia, emergency medicine, hospital medicine, pathology, and radiology. They partner with private practices, hospitals, health systems, and ambulatory surgery centers to deliver transparent and data-driven solutions.

US

  • Codes assigned accounts in accordance with the rules, regulations, and coding conventions set forth by NCHS (CDC) and AMA.
  • Abstract patient data.
  • Communicates with Care Providers by creating queries to clarify and improve documentation.

Children's Mercy is a pediatric hospital that is committed to making a difference in the lives of all children and shining a light of hope to the patients and families served. They have been recognized by U.S. News & World Report as a top pediatric hospital for eleven consecutive years.

US

  • Answer inbound patient phone calls to handle payments, insurance questions, and account management.
  • Learn and apply knowledge of insurance billing basics, including PPOs, HMOs, Medicare, and Workers Comp.
  • Manage copay collections, create billing ledgers, post payments, and complete documentation to meet daily, weekly, and monthly goals.

Luna redefines physical therapy with an award-winning technology and clinically-proven platform that connects patients and providers. Operating in 28 states with over 25 partners, it is a mission-driven, growing startup recognized for innovation in healthcare.

$30–$40/hr
US

  • Perform complex coding for CPT, HCPCS, and ICD-10 with a focus on high-impact, payer-sensitive services.
  • Lead expansion and validation of new and underutilized codes, ensuring accurate reimbursement.
  • Support analysis of coding-related denials and rejections, identifying root causes and driving upstream fixes.

Cartwheel is building a mental health program for kids that puts schools at the center, collaborating with school staff to provide earlier intervention and better coordination. They are backed by top investors and are looking for mission-driven teammates to join their team.

$75,000–$105,000/yr
US Unlimited PTO 12w maternity

  • Review and analyze medical records to ensure coding accuracy in a timely fashion
  • Identify opportunities for improvement in coding models
  • Understand and apply coding guidelines to assign appropriate codes to diagnoses and procedures as supported by clinical documentation

SmarterDx builds clinical AI that is transforming how hospitals translate care into payment. Founded by physicians in 2020, their platform connects clinical context with revenue intelligence, helping health systems recover millions in missed revenue, improve quality scores, and appeal every denial.