高级索赔编码分析师

The Senior Claims Coding Analyst – Dispute Triage & Optimization serves as a coding subject matter expert and triage coordinator responsible for optimizing the disposition of provider disputes across populations of claim scenarios.
The Senior Analyst uses coding expertise and claims data to identify dispute patterns, determine root causes, and recommend the most effective resolution approach, including individual review, standardized disposition, automation, configuration changes, policy clarification, or provider education. The role is accountable for improving cost per dispute and total administrative cost per member while maintaining payment accuracy, regulatory compliance, and a positive provider and consumer experience.
The Senior Analyst independently resolves complex coding and payment issues, supports dispute prevention efforts, and provides guidance to Claims Coding Analysts.
Duties & Responsibilities

• Serves as a triage coordinator for provider disputes, determining the appropriate resolution pathway based on coding complexity, root cause, financial impact, compliance requirements, and administrative cost.

• Analyzes dispute populations to identify trends, root causes, and opportunities for standardized, automated, or lower-cost resolution.

• Performs independent coding analysis and dispositions complex claims, disputes, and appeals using Healthfirst payment policy and applicable coding and regulatory guidelines.

• Identifies high-volume and high-cost dispute scenarios and develops population-level solutions to reduce repeat disputes and unnecessary manual review.

• Recommends and supports changes to claims edits, configuration, payment policies, workflows, automation, and provider education based on dispute findings.

• Partners with Claims, Provider Operations, Configuration, Technology, Payment Integrity, and other stakeholders to implement dispute resolution and prevention strategies.

• Monitors dispute performance, including volume, overturn and repeat rates, turnaround time, administrative cost, and resolution outcomes.

• Serves as a coding and payment policy subject matter expert, interpreting CMS, NYSDOH, CPT, HCPCS, ICD-10, AMA, and other applicable guidance.

• Reviews medical records as needed to determine appropriate coding and claim disposition.

• Clearly communicates coding and payment decisions to providers and internal stakeholders and participates in provider discussions as needed.

• Leads continuous improvement efforts focused on reducing avoidable disputes, improving provider and consumer experience, and lowering administrative expense.

• Provides day-to-day guidance and mentorship to Claims Coding Analysts.

• Performs additional duties and special projects as assigned.

Minimum Qualifications

• Coding class completion and or certification from AAPC or AHIMA, including CPC or equivalent.

• Previous professional coding and/or claims payment experience. Both payer and provider side.

• Experience researching and applying coding guidelines to complex claims or provider disputes.

• Ability to independently analyze claims and disputes and make defensible coding and payment decisions.

• High school diploma or GED from an accredited institution.

Preferred Qualifications

• Bachelor’s degree in a related field.

• Payer and/or provider-side coding or claims experience.

• Experience with provider disputes, claims operations, claims editing, claims configuration, or healthcare operations analytics.

• Consumer and/or provider experience, with an understanding of how claims and dispute decisions impact member and provider interactions.

• Experience analyzing claim or dispute populations to identify trends, root causes, and improvement opportunities.

• Understanding of operational measures including cost per dispute, administrative cost, turnaround time, productivity, automation, and quality.

• Strong analytical, critical-thinking, problem-solving, communication, and stakeholder-management skills.

• Knowledge of anatomy, medical terminology, CPT, HCPCS, ICD-10, CMS, and New York State coding and payment requirements.

Measures of Success

• Reduced cost per dispute and total administrative cost per member.

• Reduced avoidable and repeat disputes.

• Increased standardized, automated, and lower-touch dispute resolution.

• Improved turnaround time, productivity, and provider/consumer experience.

• Identification and remediation of systemic dispute root causes.

• Demonstrated financial and operational impact from dispute optimization initiatives.

WE ARE AN EQUAL OPPORTUNITY EMPLOYER. HF Management Services, LLC complies with all applicable laws and regulations. Applicants and employees are considered for positions and are evaluated without regard to race, color, creed, religion, sex, national origin, sexual orientation, pregnancy, age, disability, genetic information, domestic violence victim status, gender and/or gender identity or expression, military status, veteran status, citizenship or immigration status, height and weight, familial status, marital status, or unemployment status, as well as any other legally protected basis. HF Management Services, LLCshallnotdiscriminateagainstanydisabledemployeeorapplicantinregard to any position for which the employee or applicant is otherwise qualified.
If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to or calling 212-519-1798 . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within HF Management Services, LLC will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with HF Management Services, LLC.
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All hiring and recruitment at Healthfirst is transacted with a valid “@healthfirst.org” email address only or from a recruitment firm representing our Company. Any recruitment firm representing Healthfirst will readily provide you with the name and contact information of the recruiting professional representing the opportunity you are inquiring about. If you receive a communication from a sender whose domain is not @healthfirst.org, or not one of our recruitment partners, please be aware that those communications are not coming from or authorized by Healthfirst. Healthfirst will never ask you for money during the recruitment or onboarding process.
Hiring Range*:

• Greater New York City Area (NY, NJ, CT residents): $83,100 - $120,360

• All Other Locations (within approved locations): $73,400 - $109,225

As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision.
In addition to your salary, Healthfirst offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live.
*The hiring range is defined as the lowest and highest salaries that Healthfirst in “good faith” would pay to a new hire, or for a job promotion, or transfer into this role.
Originally posted on Himalayas