Coding Analyst II

Description Medica is a nonprofit health plan with more than a million members that serves communities in Minnesota, Nebraska, Wisconsin, Missouri, and beyond. We deliver personalized health care experiences and partner closely with providers to ensure members are genuinely cared for. We're a team that owns our work with accountability, makes data-driven decisions, embraces continuous learning, and celebrates collaboration - because success is a team sport. It's our mission to be there in the moments that matter most for our members and employees. Join us in creating a community of connected care, where coordinated, quality service is the norm and every member feels valued. The Coding Analyst II performs high-level coding, audit, and analysis activities that ensure accurate application of medical coding standards within claims, reimbursement, and operational workflows. This role interprets clinical documentation, applies established coding guidelines, and identifies discrepancies that impact claims accuracy, provider reimbursement, or regulatory compliance. It works with minimal supervision on moderately complex cases, serves as a resource to peers, and contributes to coding quality improvement efforts. The analyst also supports cross-functional partners by offering coding expertise that strengthens data integrity, payment accuracy, and operational consistency. Performs other duties as assigned. Key Accountabilities: Apply Medical Coding Standards to Claims & Clinical Documentation Review and code clinical documentation using ICD, CPT, HCPCS, and internal coding guidelines. Validate coding accuracy to support compliant billing, reimbursement, and data reporting. Research missing or unclear information to ensure proper code assignment. Complete timely coding reviews that enable accurate claims processing. Conduct Coding Reviews & Identify Discrepancies Perform audits of claims, encounters, and documentation to detect coding errors or inconsistencies. Analyze coding patterns to identify trends, risks, or gaps affecting payment accuracy. Document findings clearly and recommend corrective actions that reduce recurrence. Communicate audit results to internal partners, ensuring clarity, professionalism, and follow-through. Troubleshoot Coding-Related Issues Across Operational Processes Investigate coding impacts on claims adjudication, reimbursement, and provider disputes. Collaborate with configuration, operations, and provider teams to resolve issues efficiently. Verify coding rules within system logic and flag discrepancies for correction. Support issue triage workflows that improve operational stability and payment accuracy. Support Coding Quality, Compliance, & Documentation Standards Apply coding regulations, payer guidelines, and organizational policies consistently. Maintain compliance with regulatory requirements, audit standards, and documentation expectations. Participate in coding quality initiatives that strengthen accuracy and reduce rework. Monitor updates to coding rules and support implementation of required changes. Serve as a Knowledge Resource & Contribute to Team Objectives Provide guidance to junior analysts on coding practices, documentation requirements, and audit methods. Assist with training, documentation updates, and knowledge-sharing within the team. Participate in process improvement efforts that enhance coding workflows and accuracy. Contribute to team goals by delivering reliable expertise, consistent quality, and timely work. Required Qualifications: Bachelor's degree in Health Information Management, Healthcare Administration, Business, or a related field, or equivalent combination of education and experience 3+ years of work experience beyond degree in coding for health plan, insurance payer, facility and/or hospital Required Certifications/Licensure: Coding certification required (CCA, CPC-P, CPC, CPC-H, CCS, CCS-P, RHIT, RHIA) Preferred Qualifications: Demonstrated knowledge of revenue codes, National Uniform Billing Committee (NUBC) guidelines, UB-04 claim requirements, DRGs, and facility reimbursement methodologies Experience analyzing medical coding and claim data to determine appropriate coding, payment, and reimbursement outcomes Strong understanding of how coding impacts claim adjudication, provider reimbursement, and payment accuracy Experience researching and interpreting coding guidelines, industry standards, and healthcare billing requirements Proven analytical and problem-solving skills with the ability to investigate coding issues and identify root causes Ability to track trends, identify process improvement opportunities, and recommend upstream solutions to reduce rework and adjustments Strong written and verbal communication skills with the ability to explain coding decisions and rationale to internal stakeholders This position is a Remote role.To be eligible for consideration, candidates must have a primary home address located within any state where Medica is registered as an employer - AR, AZ, FL, GA, IA, IL, KS, KY, MI, MN, MO, ND, NE, OK, SD, TN, TX, VA, WI The full salary grade for this position is $45,900 - $78,600. While the full salary grade is provided, the typical hiring salary range for this role is expected to be between $45,900 - $68,775. Annual salary range placement will depend on a variety of factors including, but not limited to, education, work experience, applicable certifications and/or licensure, the position's scope and responsibility, internal pay equity and external market salary data. In addition to compensation, Medica offers a generous total rewards package that includes competitive medical, dental, vision, PTO, Holidays, paid volunteer time off, 401K contributions, caregiver services and many other benefits to support our employees. The compensation and benefits information is provided as of the date of this posting. Medica's compensation and benefits are subject to change at any time, with or without notice, subject to applicable law. Eligibility to work in the US: Medica does not offer work visa sponsorship for this role. All candidates must be legally authorized to work in the United States at the time of application. Employment is contingent on verification of identity and eligibility to work in the United States. We are an Equal Opportunity employer, where all qualified candidates receive consideration for employment indiscriminate of race, religion, ethnicity, national origin, citizenship, gender, gender identity, sexual orientation, age, veteran status, disability, genetic information, or any other protected characteristic. Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.