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Metro location, generalist analyst title and mid-level experience raise competition, but mandatory AAPC/AHIMA certification narrows applicants.
Requires healthcare coding certifications and payer/regulatory knowledge, limiting cross-industry transferability.
Mandatory AAPC/AHIMA certification and explicit 2–4 years' experience make filters stringent.
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Develop and maintain clinical content for Claims Editing including research and analysis using medical coding and regulatory sources.
Partner with Editing, Expert Claim Review Operations, and Product teams to ensure scalability, functionality, and growth initiatives of editing content.
Perform regulatory research and data analysis to monitor impact, communicate changes, support client inquiries, and uphold quality assurance guidelines.
Coding certification from AAPC or AHIMA mandatory.
2 to 4 years of experience in a related healthcare or coding field required.
Graduate degree or equivalent education preferred.
Knowledge of National Medicare, Medicaid regulations, and payer reimbursement policies required.
Experienced in healthcare claims editing and medical coding with a strong understanding of industry regulations and reimbursement.
Analytical and detail-oriented, skilled in data analysis and applying regulatory research to content development.
Able to manage multiple projects, communicate effectively with cross-functional teams, and handle client-facing support related to claims editing.