Clinical Operations Analyst, Medical Coding

We are seeking an individual with deep expertise in health plan operations, clinical strategy, and medical coding principles. In this dual-impact role, you will bridge the gap between clinical terminology, and operational execution. You will play a crucial role in shaping our health plan’s policies and procedures, ensuring that medical procedures and diagnoses are accurately translated into appropriate codes while driving innovative cost-containment solutions.

• Policy & Protocol Development: Support the design and implementation of clinical protocols, SOPs, and medical policies to guide the effective and accurate application of benefits.

• Coding & Compliance: Analyze medical records and plan design language to ensure accurate code assignments (ICD, CPT, HCPC) and maintain compliance with federal and state regulations, applying independent judgment in coding interpretation and compliance decisions.

• Utilization & Claims Oversight: Evaluate treatment plans, utilization management strategies, and prior authorizations while auditing large claims and itemized bills to identify discrepancies and recommend corrective actions.

• Financial & Risk Management: Partner with underwriting and stop-loss teams by providing coding insights to assess risk profiles and evaluate potential financial exposure related to medical treatments. 

• Data Analytics: Support clinical operations in the management, analysis, and oversight of clinical program data.

• Collaboration & Training: Act as a trusted advisor across the organization, providing guidance and training materials to internal staff regarding coding practices and clinical standards.

• Successful completion of a medical coding certification program. 

• Bachelor’s degree in Nursing, Health Information Management, or a related education.

• 5+ years of medical coding experience and 2+ years in a health plan, TPA, or managed care organization.

• Expert knowledge of anatomy, medical terminology, and coding systems, including experience with coding software and EHRs.

• Demonstrated ability to analyze data, identify trends, and support decision-making related to fraud, waste, and abuse, with the ability to exercise independent judgment. 

●      Previous experience at a high growth company.

In order to create a more equitable and sustainable future for employer-sponsored health insurance, we need talented people doing amazing work. In exchange, we offer a great overall employee experience with opportunities for career growth, meaningful mission-driven work, and an above average total rewards package.

The salary range for this position is $71,775 - $95,700 annually. Numerous factors including, but not limited to, education, skills, work experience, certifications, etc. will be considered when determining compensation.  

Our unique benefits program is the gravy, i.e., the special sauce that sets our compensation package apart. In addition to standard health and wellness benefits, Gravie’s package includes alternative medicine coverage, generous PTO, up to 16 weeks paid parental leave, paid holidays, a 401k program, transportation perks, education reimbursement, and paid paw-ternity leave.