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Requires niche medical coding certification but mid-level role and analytics demand create moderate competition.
High—role requires certified medical coding expertise and healthcare claims domain experience.
Mandatory 5+ years and CPC/CCS certification make hiring filters strict.
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Develop, research, build, test, and maintain claims editing rules and content using medical coding standards and proprietary sources.
Partner with operations, sales, and IT teams to scale and enhance the claims edit platform for physician and facility claims.
Provide subject matter expertise, coding support, and documentation for customer/provider inquiries and ensure HIPAA compliance and quality assurance adherence.
5+ years of experience in healthcare or related industry.
Current certified coder credential (CCS, CCS-P, CPC) or registered health information technician (RHIA/RHIT), or RN/LPN with coding knowledge; active CPC or equivalent credentialing required.
Proficiency in Microsoft Word and PowerPoint; intermediate to advanced Excel skills preferred.
Education: Bachelor’s degree preferred (business, healthcare, or technology); notice period not explicitly mentioned.
Experienced in applying medical coding knowledge to develop and maintain complex claims edits within healthcare financial systems.
Able to collaborate cross-functionally with technical, operational, and sales teams to drive scalable solutions and platform growth.
Strong analytical skills with attention to regulatory compliance (HIPAA), data trends, and coding practice changes.