Clinical Operations Analyst (Medical Coding)

TL;DR

Clinical Operations Analyst (Medical Coding): Bridging clinical terminology and operational execution to shape health plan policies and ensure accurate medical coding. Focus on designing clinical protocols, auditing large claims, and managing financial risk through coding insights.

Location: Remote (USA)

Salary: $71,775 - $95,700 annually

Company

hirify.global creates innovative health benefit solutions and services for small and midsize businesses and their employees.

What you will do

• Support the design and implementation of clinical protocols, SOPs, and medical policies.
• Analyze medical records to ensure accurate code assignments (ICD, CPT, HCPC) and maintain federal and state compliance.
• Evaluate treatment plans and audit large claims to identify discrepancies and recommend corrective actions.
• Partner with underwriting and stop-loss teams to assess risk profiles and financial exposure.
• Manage, analyze, and oversee clinical program data to support operations.
• Provide guidance and training materials to internal staff regarding coding practices and clinical standards.

Requirements

• Successful completion of a medical coding certification program.
• Bachelor’s degree in Nursing, Health Information Management, or a related field.
• 5+ years of medical coding experience.
• 2+ years of experience in a health plan, TPA, or managed care organization.
• Expert knowledge of anatomy, medical terminology, coding systems, and EHRs.
• Ability to analyze data and identify trends related to fraud, waste, and abuse.

Nice to have

• Previous experience working at a high-growth company.

Culture & Benefits

• Comprehensive health and wellness benefits, including alternative medicine coverage.
• Generous PTO and up to 16 weeks of paid parental leave.
• 401k program and education reimbursement.
• Transportation perks and paid paw-ternity leave.
• Non-hierarchical, merit-driven culture focused on consumer-centric impact.