Job Description
The Coding Policy Analyst is responsible for the coordination of technically detailed work that has a significant impact on all operations and information systems within Providence Health Plan (PHP). This position will update and create Coding Policies and associated edit configurations within the PHP claims editing system. In addition, the Coding Policy Analyst will be responsible for replying to provider and member appeals and providing appropriate CPT, CMS, specialty society, Coding Policy, and/or other official documented rationale for Coding Policy edits. The analyst is responsible for monitoring changes to codes, coding guidelines and regulations, and coding edits from external agencies such as AMA, CMS, Medicaid, and specialty societies, and assists with implementation of such changes to the claims adjudication and editing software.