Senior Specialist, Coding (Remote)
RemoteUnited States
Job Summary
Research correct coding edit inquiries, analyze edit outcomes, and validate coding rationale for Payment Integrity Prepay operations. Apply state, federal, and vendor coding guidance to support accurate claim edit outcomes and monitor savings trends. Serve as the primary subject matter expert and Health Plan point of contact for assigned states or categories, resolving coding edit inquiries and clarifying expectations with vendors and internal stakeholders. Communicate insights and provide recommendations to improve consistency and accuracy. Support development of job aids and training materials while tracking performance outcomes. Requires 3–5+ years of coding experience, active CPC or equivalent certification, and proficiency in Excel for reporting.
Required Qualifications
- Associate's Degree or equivalent work experience
- 3–5+ years of coding, payment integrity, or claims experience in a healthcare setting
- Experience supporting coding accuracy, correct coding edit review, savings analysis, and operational workflows
- Active and unrestricted coding certification, such as CPC, CCS, CCS-P, RHIT, or equivalent
Desired Qualifications
- Bachelor's Degree in Business, Healthcare, or a related field
- Experience in prepayment coding programs and payer environments
- Exposure to working with coding vendors and Health Plan partners
- Familiarity with state-specific coding and reimbursement guidelines
- Proficiency in Excel for tracking, reporting, and trend identification
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