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Protocol Intelligence
Data-driven signals on your job's competitivenessMid-level metro data role with niche medical coding requirement reduces broad applicant pool.
Highly specialized medical coding and claims editing skills limit cross-industry transferability.
Mandatory 5+ years and certified medical coding credentials create strict screening.
Job Description
Structured overview of role & requirementsAbout This Role
Develop and deliver claims edit initiatives focusing on physician and facility claims using industry-standard coding sources.
Build, test, and maintain edits in the Claims Editing library ensuring compliance with HIPAA and quality assurance standards.
Collaborate with Operations, Sales, IT, and client teams to support scalability, functionality, and issue resolution related to edits.
Minimum Requirements
5+ years of experience in healthcare or related industry.
Current certified coder credential required (CCS, CCS-P, CPC) or equivalent (RHIA/RHIT, RN, LPN with coding knowledge).
Proficiency in Microsoft Word and PowerPoint; intermediate to advanced Excel skills preferred.
Bachelor's degree preferred but not explicitly mandatory; current, active CPC or equivalent credentialing is required.
Ideal Candidate Profile
Experienced in medical coding and claims editing within healthcare, familiar with AMA, CPT, AAPC, CMS coding standards.
Capable of independently managing multiple projects related to edit build and validation, demonstrating strong analytical and problem-solving skills.
Effective communicator providing coding expertise and documentation support for complex inquiries and edits implementation.