Lead Code Edit Analyst

Summary

Team Lead Code Edit AnalysisThe Team Lead Code Edit Analysis is responsible for providing operational leadership, technical expertise, and oversight to the Code Edit Analyst team to ensure consistent, compliant, and efficient claims processing. This role serves as the subject matter expert in medical necessity, Correct Coding Initiative (CCI) requirements, and reimbursement methodologies while leading training, monitoring, performance tracking, and trending initiatives.The Team Lead ensures accurate ICD-10, CPT, HCPCS, and modifier assignments; oversees complex coding audits; identifies systemic coding and billing trends; and drives process improvement initiatives that enhance compliance, reduce denials, and optimize revenue integrity.This role collaborates closely with Billing, Coding, Clinical Departments, Revenue Integrity, CDI, Compliance, and Revenue Cycle Leadership to ensure alignment with CMS guidelines, payer regulations, and organizational performance goals.Essential Functions of RoleLeadership & Team Oversight: Provides day-to-day oversight of Code Edit Analysts, ensuring productivity, quality, and adherence to established workflows.Monitors team performance through defined KPIs, quality audits, and productivity benchmarks.Conducts regular one-on-one coaching sessions and team huddles to address performance trends and barriers.Develops and delivers onboarding and ongoing training for team members on coding updates, CMS transmittals, payer requirements, and system changes.Performs secondary reviews and quality audits of team members' work to ensure compliance and consistency.Identifies knowledge gaps and creates targeted education plans.Serves as escalation point for complex coding, billing, and compliance questions.Coding Review & Compliance Oversight: Performs advanced daily coding reviews of assigned claims to validate ICD-10, CPT, HCPCS codes, and modifier assignments.Reviews UB-04/837 and 1500 claim data against medical record documentation to ensure Medicare and commercial payer compliance.Interprets and operationalizes CMS memos, transmittals, and payer updates.Ensures adherence to AHIMA and AAPC Standards of Ethical Coding.Identifies and reports compliance risks or systemic billing vulnerabilities to leadership.Monitoring, Tracking & Trending: Monitor dashboards to track denial trends related to Pre-bill vs. post-bill edit performance.Analyzes trends and variations in professional and/or hospital claims to identify root causes.Assist in preparing monthly and quarterly trend reports for Revenue Cycle Leadership.Assist leadership in quantifying financial impact of systemic billing and coding errors and presents actionable recommendations.Tracks effectiveness of corrective actions and education initiatives.Process Improvement & Revenue Optimization: Collaborates with Chargemaster, CDI, Billing, and Clinical Departments to resolve systemic issues.Assist in developing standardized workflows to improve pre-bill review processes and reduce downstream denials.Supports contract compliance reviews and new product/service implementation.Cross-Functional Collaboration: Works with Billing Supervisors, Managers and Directors to facilitate mandated coding and compliance changes.Participate in Revenue Cycle performance improvement committees and initiatives when applicable.Minimum Qualifications/Specialized SkillsMinimum of bachelor's degree in related discipline or more than five years of extensive experience with intermediate auditing background along with a certificate in coding may be substituted.Certified Coding Specialist (CCS), CPC, RHIT or equivalent certification required.Previous leadership, mentoring, or training experience preferred.Comprehensive knowledge of CMS payment systems and reimbursement methodologies.Experience with hospital information systems and claims platforms. Epic preferred.Ability to interpret and apply regulatory guidance from CMS and third-party payers.Strong communication and presentation skills.Knowledge of Privacy Act and HIPAA compliance requirements.Skill Set RequirementProficient in reimbursement methodologies, hospital and/or professional information systems and coding methodologies.Analyze complex medical records and identify billable services.Strong quantitative, analytical, and organizational skills.Utilize and understand computer technology.Advanced knowledge of ICD-10, HCPCS and CPT-4 coding schemes.Advanced knowledge of the UB-04/837 and 1500 claim forms loop and segments.Understands charging and coding processes along with compliance guidelines.Ability to research and interpret payer regulations and coding guidelines.Requires knowledge of medical terminology, anatomy and physiology.Strong interpersonal and leadership capabilities.Standards of PerformanceDemonstrate increased revenue and compliance as a result of successful accuracy and correctness of the following: Accuracy & Compliance: Sustained improvement in coding edits accuracy rates.Reduction in coding-related denials.Timely resolution of claims processing questions.Identification of over- and under-coding opportunities.Leadership & Monitoring: Ensure team productivity and quality benchmarks are consistently met or exceeded.Document team members training and education plans.Tracking and trending reports shared with leadership.Successful onboarding and competency validation of new analysts.Revenue Impact: Provides education to revenue producing department staff as requested by department supervisors, managers and/or director.Reduce downstream coding and billing errors.Measurable improvement in pre-bill and/or coding edit performance.Process Improvement: Implementation of sustainable workflow enhancements.Complete performance improvement initiatives resulting in operational efficiencies.Proactive identification of revenue opportunities.Works with department supervisors, managers and directors to facilitate mandated changes.Meets productivity and accuracy standards as defined by Billing Manager or Revenue Cycle Leadership Team.Pay Range $30.00 - $43.73/hrRemote role (based out of Greenville, NC) Monday - Friday, full-time, day shift: Training hours: 8:00 a.m. - 4:30 p.m. Great Benefits

Job Description

Team Lead Code Edit AnalysisThe Team Lead Code Edit Analysis is responsible for providing operational leadership, technical expertise, and oversight to the Code Edit Analyst team to ensure consistent, compliant, and efficient claims processing. This role serves as the subject matter expert in medical necessity, Correct Coding Initiative (CCI) requirements, and reimbursement methodologies while leading training, monitoring, performance tracking, and trending initiatives.The Team Lead ensures accurate ICD-10, CPT, HCPCS, and modifier assignments; oversees complex coding audits; identifies systemic coding and billing trends; and drives process improvement initiatives that enhance compliance, reduce denials, and optimize revenue integrity.This role collaborates closely with Billing, Coding, Clinical Departments, Revenue Integrity, CDI, Compliance, and Revenue Cycle Leadership to ensure alignment with CMS guidelines, payer regulations, and organizational performance goals.Essential Functions of RoleLeadership & Team Oversight: Provides day-to-day oversight of Code Edit Analysts, ensuring productivity, quality, and adherence to established workflows.Monitors team performance through defined KPIs, quality audits, and productivity benchmarks.Conducts regular one-on-one coaching sessions and team huddles to address performance trends and barriers.Develops and delivers onboarding and ongoing training for team members on coding updates, CMS transmittals, payer requirements, and system changes.Performs secondary reviews and quality audits of team members' work to ensure compliance and consistency.Identifies knowledge gaps and creates targeted education plans.Serves as escalation point for complex coding, billing, and compliance questions.Coding Review & Compliance Oversight: Performs advanced daily coding reviews of assigned claims to validate ICD-10, CPT, HCPCS codes, and modifier assignments.Reviews UB-04/837 and 1500 claim data against medical record documentation to ensure Medicare and commercial payer compliance.Interprets and operationalizes CMS memos, transmittals, and payer updates.Ensures adherence to AHIMA and AAPC Standards of Ethical Coding.Identifies and reports compliance risks or systemic billing vulnerabilities to leadership.Monitoring, Tracking & Trending: Monitor dashboards to track denial trends related to Pre-bill vs. post-bill edit performance.Analyzes trends and variations in professional and/or hospital claims to identify root causes.Assist in preparing monthly and quarterly trend reports for Revenue Cycle Leadership.Assist leadership in quantifying financial impact of systemic billing and coding errors and presents actionable recommendations.Tracks effectiveness of corrective actions and education initiatives.Process Improvement & Revenue Optimization: Collaborates with Chargemaster, CDI, Billing, and Clinical Departments to resolve systemic issues.Assist in developing standardized workflows to improve pre-bill review processes and reduce downstream denials.Supports contract compliance reviews and new product/service implementation.Cross-Functional Collaboration: Works with Billing Supervisors, Managers and Directors to facilitate mandated coding and compliance changes.Participate in Revenue Cycle performance improvement committees and initiatives when applicable.Minimum Qualifications/Specialized SkillsMinimum of bachelor's degree in related discipline or more than five years of extensive experience with intermediate auditing background along with a certificate in coding may be substituted.Certified Coding Specialist (CCS), CPC, RHIT or equivalent certification required.Previous leadership, mentoring, or training experience preferred.Comprehensive knowledge of CMS payment systems and reimbursement methodologies.Experience with hospital information systems and claims platforms. Epic preferred.Ability to interpret and apply regulatory guidance from CMS and third-party payers.Strong communication and presentation skills.Knowledge of Privacy Act and HIPAA compliance requirements.Skill Set RequirementProficient in reimbursement methodologies, hospital and/or professional information systems and coding methodologies.Analyze complex medical records and identify billable services.Strong quantitative, analytical, and organizational skills.Utilize and understand computer technology.Advanced knowledge of ICD-10, HCPCS and CPT-4 coding schemes.Advanced knowledge of the UB-04/837 and 1500 claim forms loop and segments.Understands charging and coding processes along with compliance guidelines.Ability to research and interpret payer regulations and coding guidelines.Requires knowledge of medical terminology, anatomy and physiology.Strong interpersonal and leadership capabilities.Standards of PerformanceDemonstrate increased revenue and compliance as a result of successful accuracy and correctness of the following: Accuracy & Compliance: Sustained improvement in coding edits accuracy rates.Reduction in coding-related denials.Timely resolution of claims processing questions.Identification of over- and under-coding opportunities.Leadership & Monitoring: Ensure team productivity and quality benchmarks are consistently met or exceeded.Document team members training and education plans.Tracking and trending reports shared with leadership.Successful onboarding and competency validation of new analysts.Revenue Impact: Provides education to revenue producing department staff as requested by department supervisors, managers and/or director.Reduce downstream coding and billing errors.Measurable improvement in pre-bill and/or coding edit performance.Process Improvement: Implementation of sustainable workflow enhancements.Complete performance improvement initiatives resulting in operational efficiencies.Proactive identification of revenue opportunities.Works with department supervisors, managers and directors to facilitate mandated changes.Meets productivity and accuracy standards as defined by Billing Manager or Revenue Cycle Leadership Team.Pay Range $30.00 - $43.73/hrRemote role (based out of Greenville, NC) Monday - Friday, full-time, day shift: Training hours: 8:00 a.m. - 4:30 p.m. Great Benefits