Clinical Operations Analyst, Medical Coding

1 week, 4 days ago
Full-time
Senior
Data Science and Analytics
Gravie

Gravie

Gravie is reinventing health benefits with transparent, affordable solutions like Comfort® plan, ensuring easy access to care for employers and individuals.

Insurance
251-1K
Founded 2013
$177M raised

Description

  • Support the design and implementation of clinical protocols, SOPs, and medical policies.
  • Analyze medical records and plan design language to ensure accurate ICD, CPT, and HCPC code assignments.
  • Maintain compliance with federal and state regulations and apply independent judgment in coding and compliance decisions.
  • Evaluate treatment plans, utilization management strategies, and prior authorizations.
  • Audit large claims and itemized bills to identify discrepancies and recommend corrective actions.
  • Partner with underwriting and stop-loss teams to assess risk and financial exposure related to medical treatments.
  • Support the management, analysis, and oversight of clinical program data.
  • Provide guidance and training materials to internal staff on coding practices and clinical standards.

Requirements

  • Successful completion of a medical coding certification program.
  • Bachelor’s degree in Nursing, Health Information Management, or a related field.
  • 5+ years of medical coding experience.
  • 2+ years of experience in a health plan, TPA, or managed care organization.
  • Expert knowledge of anatomy, medical terminology, and coding systems.
  • Experience with coding software and EHRs.
  • Demonstrated ability to analyze data, identify trends, and support decisions related to fraud, waste, and abuse.
  • Ability to exercise independent judgment.
  • Previous experience at a high-growth company is preferred.

Benefits

  • Salary range of $71,775 to $95,700 annually.
  • Above-average total rewards package.
  • Standard health and wellness benefits.
  • Alternative medicine coverage.
  • Generous PTO.
  • Up to 16 weeks of paid parental leave.
  • Paid holidays.
  • 401(k) program.
  • Transportation perks.
  • Education reimbursement.
  • Paid paw-ternity leave.

Interested in this position?

Apply directly on the company website

Apply Now

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