Claims Coding Analyst

The Claims Coding Analyst’s primary responsibilities require independent judgement in making coding-based decisions on claims and appeals to maintain and enhance Healthfirst’s claims editing systems in ensuring proper claims payments, reviewing, researching, and responding to written and emailed correspondence from providers regarding claim denials, and acting as a subject matter expert handling more complex provider issues. They are involved in setting Healthfirst claims policy and ensure that Healthfirst payment policy is aligned with CMS (Centers for Medicare and Medicaid Services), New York State Department of Health (NYSDOH), and all CPT, HCPCS, and ICD-10 coding guidelines, among others.