This list contains only the countries for which job offers have been published in the selected language (e.g., in the French version, only job offers written in French are displayed, and in the English version, only those in English).
Our Client is seeking a Benefit & Coding Analyst III to analyze, develop, and maintain benefit and coding requirements at the enterprise level across multiple markets and lines of business. This role requires deep expertise in medical coding, benefit configuration, and regulatory compliance to ensure system accuracy and alignment with benefit definitions. The analyst will collaborate with cross-functional teams to interpret requirements, troubleshoot issues, and provide subject matter expertise supporting configuration, product strategy, operational processes, and system accuracy. The Benefit & Coding Analyst III will also play a key role in supporting annual benefit changes, quarterly coding updates, and ensuring compliance with federal, state, and CMS regulations. The ideal candidate will have at least five years of experience in medical coding and benefit configuration, strong analytical and communication skills, and a thorough understanding of Medicare, Medicaid, and Marketplace benefit structures.
Job Responsibility:
Analyze and translate complex medical benefit requirements into system configurations and coding specifications across multiple states and product lines
Develop, maintain, and validate code-level benefit definitions using correct coding methodologies, coding guidelines, and regulatory requirements
Create and review configuration templates and benefit grids to ensure alignment between benefit intent, coding logic, and system design
Research and interpret federal, state, and CMS regulations, including prior authorizations, EHB requirements, OPPS rules, MHPAEA compliance, and provider contract alignment
Participate in and support annual benefit change and quarterly coding update processes, ensuring timely implementation and compliance
Utilize reporting tools to analyze data, conduct impact assessments, resolve issues, and perform root cause analysis
Support cross-functional teams through effective communication, documentation, process improvement, and troubleshooting
Provide mentorship, peer reviews, and training to colleagues to ensure consistency and quality of work
Create and maintain SOPs, process flows, and operational documentation
Serve as backup or lead on assigned projects, internal/external meetings, and operational priorities as needed
Requirements:
Bachelor’s degree in a related field or equivalent experience required
Minimum five (5) years of experience in medical coding, benefit plan design, benefit configuration, or claims processing
Subject matter expertise in CPT, HCPCS, and ICD-CM coding
Experience with benefit configuration systems (Facets or equivalent preferred)
Strong analytical, problem-solving, and critical thinking skills
Understanding of claims-related reference data (revenue codes, bill types, POS, etc.)
Knowledge of Medicare, Medicaid, and Marketplace benefit structures highly preferred
Managed Care experience strongly preferred
Proficient with Microsoft Office Suite
database knowledge preferred
Strong written and verbal communication skills
Ability to work independently or collaboratively in a fast-paced environment
Nice to have:
Knowledge of Medicare, Medicaid, and Marketplace benefit structures highly preferred
Managed Care experience strongly preferred
database knowledge preferred
What we offer:
competitive medical, dental, vision, Health Savings Account, Dependent Care FSA, and supplemental coverage with plans that can fit each employee’s needs
401k plan that includes a company match and is fully vested after you become eligible
paid time off
sick time
paid company holidays
Employee Assistance Program (EAP) that provides services like virtual counseling, financial services, legal services, life coaching