Certified Medical Coding Specialist

As part of our US Healthcare Payment Integrity and Customer Success organization, you will use your technical and clinical coding knowledge to help implement and support solutions that improve claim payment accuracy. Working closely with senior specialists, product, and technical teams, you will help validate edit logic, assist with audits, and identify opportunities to reduce waste and recover overpayments for our customers.

What you’ll do

• Support Claim Accuracy: Assist in managing pre-pay and post-pay workflows, including claim editing and recovery processes.
• Operationalize Logic: Help define and validate claim edit logic and payment integrity rules to ensure they are functioning correctly for customers.
• Conduct Focused Audits: Perform medical coding audits (inpatient, outpatient, professional) by validating ICD, CPT, HCPCS, and DRG codes under the guidance of senior staff.
• Assist with Reviews: Support the customer appeals process by reviewing billed services and assessing their alignment with policies and coding guidelines.
• Policy Research: Monitor payer policies and industry benchmarks to identify potential gaps in the current edit library and suggest improvements.
• Cross-Functional Collaboration: Partner with Product and Engineering teams to assist in testing, troubleshooting, and User Acceptance Testing (UAT) for new and updated rules.
• Documentation: Maintain clear documentation of audit findings and project progress for internal and external stakeholders.

What you bring

• 3+ years of experience in healthcare claims, provider billing, or health plan payment integrity.
• 2+ years as a certified medical coder in a payer, provider, or RCM environment.
• Solid Foundation: Working knowledge of Medicare, Medicaid, and Commercial payer regulations.
• Attention to Detail: Proficiency in auditing for coding accuracy (ICD, CPT, HCPCS, modifiers).
• Analytical Mindset: Ability to review data and identify trends or inconsistencies that impact claim accuracy.
• Communication Skills: Strong written and verbal skills; ability to explain technical coding findings clearly to team members.
• Adaptability: Ready to learn and grow in a fast-paced environment while managing multiple tasks effectively.

Qualifications and core requirements

• Education: Bachelor’s degree in Healthcare Administration, Business, or a related field (or equivalent experience).
• Certification: Active medical coding credentials required (CPC, CCS, or CCA).

The range listed is for base compensation. Your actual base salary will vary based on factors including location and individual qualifications objectively assessed during the interview process.

In addition to base salary, your total rewards package will include additional components such as incentive pay and benefits. If you're interviewing for this role, speak with your Talent Acquisition Partner to learn more about the specific details for this position.

Base Salary Pay Range

$65,000

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$95,000 USD