Description
We're building a world of health around every individual , shaping a more connected, convenient and compassionate health experience.
The Provider Flag Management Senior Coding Analyst is responsible for supporting the monitoring and ongoing management of provider flags across Commercial, Medicare, and Medicaid lines of business.
Key Responsibilities:
- Review and analyze provider flag requests, including claim volume, financial impact, and inventory implications.
- Partner with investigation, coding, and CCR teams to construct recommendations and present findings to leadership and governance committees.
- Collaborate with SIU Investigators, Coding, Prevention, CCR, and Medical Directors via flag governance facilitation.
- Monitor existing CCR, coding and administratively denied flags and evaluate performance metrics to support continuation, modification, or removal recommendations.
- Identify opportunities for mitigation strategies and operational improvements when flag placement is not approved or requires modification.
Required Qualifications and Skills:
- 3+ years of experience in Behavioral Health and Medical Coding.
- Knowledge of Commercial, Medicare, and Medicaid claims processing and payment methodologies.
- Experience analyzing healthcare claims data and utilizing reporting tools to identify trends, risks, or operational opportunities.
- Demonstrated experience managing multiple priorities, projects, or workflows in a fast-paced environment.
- Experience with Microsoft Excel, reporting tools, and healthcare data analysis.
- Experience collaborating across multiple departments to drive processes, resolve issues, and achieve business objectives.
- Must be able to travel to provide testimony if needed.
Preferred Qualifications:
- Experience supporting provider flag management, provider review programs, claims editing, payment integrity, SIU, or fraud/waste/abuse initiatives.
- Experience working with provider data, NPI/TIN structures, claim inventory management, or case management systems.
- Familiarity with healthcare coding principles, medical record review processes, or claim adjudication workflows.
- Knowledge of healthcare regulations, compliance standards, and fraud prevention strategies.
- Experience facilitating governance reviews, stakeholder meetings, and presenting recommendations to senior leadership.
- Strong analytical, critical thinking, and problem-solving skills with the ability to make data-driven recommendations.
- Excellent written and verbal communication skills with experience presenting findings to business partners and leadership.
- Experience working in Microsoft PowerPoint.
Education:
- AAPC Certified Professional Coder Certification (CPC).
- GED or High School diploma.
Anticipated Weekly Hours: 40
Time Type: Full time
Pay Range: $46,988.00 - $112,200.00
Benefits: This full-time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.