Requirements 5 or more years of experience in clinical analysis and medical coding within a healthcare payor environment. Proficiency in ICD-10, CPT, and HCPCS coding methodologies as a licensed RN and CPC or CCS. Experience with medical coding software such as Optum Encoder and automated claims adjudication platforms. Experience in translating clinical policy into structured business rules and technical functional specifications. Experience with medical necessity reviews, program integrity audi