[Hiring] Lead Code Edit Analyst @ECU Health Medical Center

Role Description

The 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.

Qualifications

• Minimum 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.

Requirements

• Proficient 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.

Benefits

• Remote role (based out of Greenville, NC)
• Monday - Friday, full-time, day shift:
• Training hours: 8:00 a.m. - 4:30 p.m.
• Great Benefits

Company Description

ECU Health is a mission-driven, 1,708-bed academic health care system serving more than 1.4 million people in 29 eastern North Carolina counties. The not-for-profit system is comprised of 13,000 team members, nine hospitals and a physician group that encompasses over 1,100 academic and community providers practicing in over 180 primary and specialty clinics located in more than 130 locations.

The flagship ECU Health Medical Center, a Level I Trauma Center, and ECU Health Maynard Children’s Hospital serve as the primary teaching hospitals for the Brody School of Medicine at East Carolina University. ECU Health and the Brody School of Medicine share a combined academic mission to improve the health and well-being of eastern North Carolina through patient care, education and research.