Healthfirst · 16 hours ago
Claims Coding Analyst
New York, NY
Full-time
Hybrid
Mid Level
$69K/yr - $100K/yrHealthfirst is a healthcare organization seeking a Claims Coding Analyst to enhance their claims editing systems and ensure proper claims payments. The role involves making coding-based decisions on claims and appeals, collaborating with departments, and serving as a subject matter expert on claims policy disputes.
Commercial InsuranceHealth CareHealth InsuranceInsurance
Responsibilities
Conducts independent assessments of current claims edits to ensure comprehensive and defensible claims editing is in place across all Healthfirst product lines
Proactively identifies areas of opportunity with respect to new edits, modifications to existing edits, and recommended claims policy changes
Leads implementation efforts with respect to new or modified edits and works with other departments to ensure proper integration with existing systems and edits
Monitors and reports on performance of current claims editing packages to substantiate savings to Healthfirst
Serves as a subject matter expert to defend claims payment policy disputes and appeals
Reviews claims editing escalated provider disputes/appeals and provides guidance on coding rules and industry standards across all areas of the company with regards to claims editing and proper coding, billing, and payment
Researches and provides feedback on claims editing performance issues, both internally and externally with providers, vendors, etc
Collaborates with claims editing vendors to maintain and update edits as changes in the regulatory, legislative, or industry accepted payment policy requires
Collaborates with other departments to improve compliance with coding conventions and clinical practice guidelines
Leads continuous improvement and quality initiatives to improve processes across departments
Reviews and responds to written provider disputes, clearly and articulately outlining the payment discrepancy to the provider
Thoroughly researches post payment claims and takes appropriate action to resolve identified issues within turnaround time requirements and quality standards
Navigates CMS and State specific websites, as well as AMA guidelines, and compares to current payment policy configuration to resolve the provider payment discrepancies
Reviews medical records to ensure coding is consistent with the services billed and compares against the clinical coding guidelines to determine if a claim adjustment is necessary
Processes claim adjustment requests following all established adjustment and claim processing guidelines
Identifies and escalates root cause issues to supervisor for escalated review
Reviews and responds independently to internally escalated provider disputes transferred by management and other associates
Additional duties as assigned
Qualification
Required
Coding certification from either American Academy of Professional Coders (AAPC), Certified Professional Coders (CPC) or American Health Information Management Association (AHIMA)
High school diploma or GED from an accredited institution
Preferred
Previous relevant experience
Bachelor's degree in related field
Time management, critical/creative thinking, communication, and problem-solving skills
Demonstrated professional writing, electronic documentation, and assessment skills
Intermediate Outlook, Basic Word, Excel, PowerPoint, Adobe Acrobat skills
Knowledge of anatomy and pathophysiology medical terminologies
Benefits
Medical, dental and vision coverage
Incentive and recognition programs
Life insurance
401k contributions
Company
Healthfirst
Healthfirst is a health insurer providing medical, business, and health insurance services.
Founded in 1993
1001-5000 employees
H1B Sponsorship
Healthfirst has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (35)
2024 (26)
2023 (19)
2022 (31)
2021 (3)
2020 (11)
Funding
Current Stage
Late StageLeadership Team
Pat Wang
President and CEO
Recent News
2025-10-10
Crain's New York Business
2025-09-23
2025-08-21
Company data provided by crunchbase