Coding Policy Analyst

Coding Policy Analyst

The Coding Policy Analyst is responsible for coordinating technically detailed work that has a significant impact on all operations and information systems within Providence Health Plan (PHP). This position updates and creates Coding Policies and associated edit configurations within PHP’s claims editing system. The analyst replies to provider and member appeals and provides appropriate CPT, CMS, specialty society, Coding Policy, or other official documented rationale for Coding Policy edits.

The analyst monitors 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. The analyst serves as a coding subject matter expert to other departments within PHP for questions about CPT, HCPCS, and ICD‑10 codes, and coding guidelines and regulations.

The analyst works closely with the Benefits Management Team and Regulatory Department to ensure coding edits are applied in a manner consistent with member benefits and all state and federal insurance regulations.

Providence Health Plan welcomes 100% remote work for applicants who reside in the following states:

• Washington
• Oregon
• California

California:
Humboldt:
Min: $33.05, Max: $51.30

California:
All Northern California – Except Humboldt:
Min: $37.08, Max: $57.56

California:
All Southern California – Except Bakersfield:
Min: $33.05, Max: $51.30

California:
Bakersfield:
Min: $31.71, Max: $49.22

Oregon:
Non‑Portland Service Area:
Min: $29.56, Max: $45.88

Oregon:
Portland Service Area:
Min: $31.71, Max: $49.22

Washington:
Western – Except Tukwila:
Min: $33.05, Max: $51.30

Washington:
Southwest – Olympia, Centralia & Below:
Min: $31.71, Max: $49.22

Washington:
Tukwila:
Min: $33.05, Max: $51.30

Washington:
Eastern:
Min: $28.21, Max: $43.80

Washington:
South Eastern:
Min: $29.56, Max: $45.88

• Coding certification through AAPC (CPC) or AHIMA (CCS) upon hire.
• 5 years of experience directly related to CPT coding from chart extraction with a health care provider, a health insurance company, or a capitated managed care company.
• 5 years of excellent writing and grammar skills required.
• 5 years of demonstrated experience in detailed coding applications, as well as Microsoft Office capabilities, such as Excel, Word, and Access.

• Bachelor's Degree or experience in a Healthcare or Health Plan setting coding and auditing will also be considered.
• 2 years of experience with Facets Claims Adjudication system and/or Optum CES editing software.

Providence is proud to be an Equal Opportunity Employer. We are committed to the principle that every workforce member has the right to work in surroundings that are free from all forms of unlawful discrimination and harassment on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.

We believe diversity makes us stronger, so we are dedicated to shaping an inclusive workforce, learning from each other, and creating equal opportunities for advancement.

Our benefits include a comprehensive package with retirement 401(k) Savings Plan with employer matching, health care benefits (medical, dental, vision), life insurance, disability insurance, time off benefits (paid parental leave, vacations, holidays, health issues), voluntary benefits, well‑being resources, and more.