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Moderate: niche coding certification required, but metro location and mid-level experience increase applicant pool.
High: role requires specialized healthcare coding and payer regulation expertise, limiting cross-industry transferability.
High: mandatory AAPC/AHIMA certification, explicit years, and domain-specific Medicare/payer knowledge.
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Own concept development and content management for Claims Editing, including research, analysis, and creation of clinical edit content using medical coding standards.
Partner with Editing, Expert Claim Review Operations, and Product teams to develop, maintain, and scale content ensuring compliance with regulatory standards and business impact.
Analyze data and trends to support product alerts, quality assurance, and recommend enhancements related to content expansion and automation.
Graduate degree or equivalent required.
Mandatory coding certification from AAPC or AHIMA.
2 to 4 years of experience in a related healthcare coding or claims editing field.
Knowledge of National Medicare and Medicaid regulations and payer reimbursement policies is required.
Experienced in clinical coding and healthcare industry with proficiency in medical coding standards (ICD-10, CPT, CMS, etc.) and claims editing processes.
Strong analytical skills to evaluate data trends and impact of content changes, with an ability to communicate effectively with cross-functional teams including Product Management.
Capable of managing multiple projects simultaneously with strong attention to detail, quality assurance orientation, and proactive problem-solving within a regulated healthcare environment.