Clinical Policy Coding Analyst

Location: Remote-IN; must be authorized to work in the United States without employment-based visa sponsorship now or in the future

Salary: $70,100–$126,200 per year

Company

hirify.global is a diversified national healthcare organization serving 28 million members.

What you will do

• Review and update coding for Clinical Coverage Guidelines and Claims Edit Guidelines supporting medical necessity reviews and claims payment policies.
• Research state and federal regulations, coding industry guidelines, Medicare and Medicaid requirements, and related clinical policies.
• Coordinate the hand-off and implementation of coding edits across the Coding Integrity, Medical Management Platform, Systems Integration, and Digital Communications teams.
• Evaluate coding rule change requests from clinical, financial, claims operations, contractual, and regulatory perspectives.
• Support vendor management, new market implementations, authorization tools, external medical reviews, and cross-functional initiatives.
• Serve as a coding and claims payment subject matter expert for policy committees, audits, escalated disputes, and complex coding inquiries.

Requirements

• Associate degree in a related field or equivalent experience.
• At least 4 years of experience in medical coding within a facility, provider, or payer organization.
• Knowledge of Medicare and Medicaid.
• One of the following certifications is required: RHIA, RHIT, CCS, CCS-P, CPC, or CPC-H.
• U.S. work authorization is required; employment-based visa sponsorship is not available, including current or future sponsorship.
• Ability to meet productivity and accuracy standards and support regulatory, contractual, compliance, and audit requirements.

Culture & Benefits

• Remote work with a flexible approach to remote, hybrid, field, or office schedules.
• Health insurance, 401(k), and stock purchase plans.
• Tuition reimbursement, paid time off, and holidays.
• Compensation may vary based on skills, experience, education, job-related factors, and employment status.