Job Overview
Location
Remote
Job Type
Full-time
Category
Software Engineering
Date Posted
May 7, 2026
Full Job Description
đź“‹ Description
- • The Vendor Medical Coding Analyst ensures the accuracy and efficiency of vendor payment processes by analyzing medical records and validating diagnostic and procedural codes against coding guidelines and medical necessity.
- • Day-to-day responsibilities include auditing medical documentation, identifying root causes of claims issues, leading solutioning sessions with vendors and internal teams, implementing process improvements, conducting audits, generating reports on claim impact, and serving as a subject matter expert on reimbursement for submitted codes.
- • The role involves tracking issue resolution, developing test cases for coding compliance, monitoring adherence to protocols, and building cross-functional relationships with operational departments, markets, and Quality leaders.
- • The analyst must maintain knowledge of federal and state regulations (CMS, ODJFS, MDCH), exercise discretion and confidentiality, and represent CareSource professionally when interfacing with vendors.
- • This role is critical to ensuring compliant, accurate claims processing and supports vendor accountability and process excellence within a managed care environment.
🎯 Requirements
- • Bachelor’s degree required (or equivalent relevant work experience)
- • Three (3) years of medical billing and coding experience required
- • Certified Medical Coder (CPC, RHIT, or RHIA) required
- • Three (3) years of claims payment experience required
- • Intermediate proficiency in Facets, Microsoft Word, Excel, PowerPoint, and Access
- • Knowledge of diagnosis codes, CPT guidelines, medical terminology, anatomy, physiology, and Medicare/Medicaid/Commercial reimbursement
🏖️ Benefits
- • Competitive salary range of $54,500.00 to $87,300.00
- • Potential for performance-based bonus tied to company and individual results
- • Comprehensive total rewards package supporting employee well-being
- • Opportunity to work remotely
- • Professional development through involvement in process improvement and cross-functional collaboration
- • Exposure to federal and state healthcare regulations and industry coding standards
Skills & Technologies
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About CareSource Management Group Company
CareSource is a nonprofit, multi-state managed care organization headquartered in Dayton, Ohio. Founded in 1989, it administers Medicaid, Medicare Advantage, and Marketplace health plans serving over two million members in Ohio, Kentucky, Indiana, West Virginia, and Georgia. The company focuses on improving health outcomes for low-income and vulnerable populations through integrated care management, behavioral health services, and social determinants programs.
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