Job Description:
• Assist in managing pre-pay and post-pay workflows, including claim editing and recovery processes.
• Help define and validate claim edit logic and payment integrity rules to ensure they are functioning correctly for customers.
• Perform medical coding audits (inpatient, outpatient, professional) by validating ICD, CPT, HCPCS, and DRG codes under the guidance of senior staff.
• Support the customer appeals process by reviewing billed services and assessing their alignment with policies and coding guidelines.
• Monitor payer policies and industry benchmarks to identify potential gaps in the current edit library and suggest improvements.
• Partner with Product and Engineering teams to assist in testing, troubleshooting, and User Acceptance Testing (UAT) for new and updated rules.
• Maintain clear documentation of audit findings and project progress for internal and external stakeholders.
Requirements:
• 2+ years of experience in healthcare claims, provider billing, or health plan payment integrity.
• 1+ years as a certified medical coder in a payer, provider, or RCM environment.
• Working knowledge of Medicare, Medicaid, and Commercial payer regulations.
• Proficiency in auditing for coding accuracy (ICD, CPT, HCPCS, modifiers).
• Ability to review data and identify trends or inconsistencies that impact claim accuracy.
• Strong written and verbal skills; ability to explain technical coding findings clearly to team members.
• Ready to learn and grow in a fast-paced environment while managing multiple tasks effectively.
Benefits:
• Flexible remote and hybrid working options
• Competitive Salary and a variable component tied to personal and company performance
• Multiple Learning and Development opportunities, including Focus Fridays, a half-day each month to focus on learning and personal growth
• Generous PTO and paid holidays
• Mental health benefits
• 2 MAD Days per year (Make A Difference Days for paid volunteering)
Apply Now
Apply Now