The Lead Code Edit Analyst provides operational leadership and technical oversight to the coding team to ensure compliant and efficient claims processing. This role monitors performance KPIs, conducts quality audits, and drives process improvement initiatives to optimize revenue integrity.
The Coding Specialist reviews medical record documentation to extract data and apply accurate diagnosis and procedure codes for a multi-specialty physician group. They are responsible for maintaining coding accuracy, managing claims edits, and ensuring compliance with regulatory guidelines.
The Code Edit Analyst performs daily coding reviews on claims to validate ICD-10, CPT, and HCPCS codes while ensuring compliance with medical necessity requirements. They also develop reports, analyze audit outcomes, and assist in process improvement initiatives to optimize revenue cycle performance.
The Senior Reimbursement Analyst manages net revenue integrity, prepares annual cost reports, and coordinates audits for Medicare and Medicaid. They also provide analytical support for financial planning, maintain reserve models, and recommend process improvements for reimbursement services.
The Team Lead oversees credit balance resolution staff, providing training and monitoring daily workflows to ensure accurate reconciliation of accounts. They are responsible for resolving complex credit balances, undistributed payments, and refund requests while maintaining compliance with regulatory and contractual requirements.
