Job Details

Coding Policy Analyst

The Coding Policy Analyst is responsible for the coordination of technically detailed work that has a significant impact on all operations and information systems within Providence Health Plan (PHP). This position will update and create Coding Policies and associated edit configurations within the PHP claims editing system. In addition, the Coding Policy Analyst will be responsible for replying to provider and member appeals and providing appropriate CPT, CMS, specialty society, Coding Policy, and/or other official documented rationale for Coding Policy edits. The analyst is responsible for monitoring changes to codes, coding guidelines and regulations, and coding edits from external agencies such as AMA, CMS, Medicaid, and specialty societies, and assists with implementation of such changes to the claims adjudication and editing software. This position requires extensive knowledge of AMA and CMS coding guidelines, policies, and regulations. This person will serve as a coding subject matter expert to other departments within PHP for questions about CPT, HCPCS, and ICD-10 codes, as well as coding guidelines and regulations. The analyst will work closely with the Benefits Management Team and Regulatory Department to ensure coding edits are applied in a manner consistent with member benefits and all state and federal insurance regulations.

Providence Health Plan caregivers are not simply valued - they're invaluable. Join our team and thrive in our culture of patient-focused, whole-person care built on understanding, commitment, and mutual respect. Your voice matters here, because we know that to inspire and retain the best people, we must empower them. Providence Health Plan welcomes 100% remote work for applicants who reside in the following states: Washington, Oregon, California.

Required Qualifications:

• Coding certification through AAPC (CPC) or AHIMA (CCS) upon hire.
• 5 years of experience directly related to CPT coding from chart extraction with a health care provider, a health insurance company, or a capitated managed care company.
• 5 years of excellent writing and grammar skills required.
• 5 years of demonstrated experience in detailed coding applications, as well as Microsoft Office capabilities, such as Excel, Word, and Access.

Preferred Qualifications:

• Bachelor's Degree or experience in a Healthcare or Health Plan setting coding and auditing will also be considered.
• 2 years of experience with Facets Claims Adjudication system and/or Optum CES editing software.

Salary Range by Location:

• California: Humboldt: Min: $33.05, Max: $51.30
• California: All Northern California - Except Humboldt: Min: $37.08, Max: $57.56
• California: All Southern California - Except Bakersfield: Min: $33.05, Max: $51.30
• California: Bakersfield: Min: $31.71, Max: $49.22
• Oregon: Non-Portland Service Area: Min: $29.56, Max: $45.88
• Oregon: Portland Service Area: Min: $31.71, Max: $49.22
• Washington: Western - Except Tukwila: Min: $33.05, Max: $51.30
• Washington: Southwest - Olympia, Centralia & Below: Min: $31.71, Max: $49.22
• Washington: Tukwila: Min: $33.05, Max: $51.30
• Washington: Eastern: Min: $28.21, Max: $43.80
• Washington: South Eastern: Min: $29.56, Max: $45.88

Our best-in-class benefits are uniquely designed to support you and your family in staying well, growing professionally, and achieving financial security. We take care of you, so you can focus on delivering our Mission of caring for everyone, especially the most vulnerable in our communities.