Claims Auditor, Reviewer, Coder

Planned Systems International

Claims Auditor, Reviewer and Coder providing expertise in quality assurance and medical coding for the WTC Health Program. Supporting audit activities and claims processing for a federal health care program.

Posted 7/2/2026full-timeRemote • 🇺🇸 United StatesMid-LevelSeniorWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in quality assurance, medical coding, and claims auditing within healthcare settings, with a strong focus on analyzing claims data and improving program policies. Proficient in collaborating with various stakeholders to enhance processes and ensure compliance with medical coding standards.

Highest-signal resume keywords

Quality Assurance ExpertiseClaims Processing ExperienceMedical Coding ProficiencyCPT, HCPC, and ICD Billing Codes KnowledgeHealth Information Management Degree

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Claims AuditingData AnalysisMedical Coding StandardsProgram Policy DevelopmentClaims Review

Soft Skills

CollaborationCommunication

Tools & Technologies

Microsoft Office SuiteExcelOutlookSharePoint

Certifications & Qualifications

Registered Health Information Administrator (RHIA)Registered Health Information Technician (RHIT)Certified Coding Specialist (CCS)

Industry Keywords

Health Insurance Payor Claims DataManaged CareFederal Payer Coverage PoliciesOccupational Health

About the role

Key responsibilities & impact

provide expertise in quality assurance, claims processing, medical coding, and audit activities
support quality assurance and audit planning
conduct claims reviews and audits
analyze claims data to identify trends and issues
research federal payer coverage policies
develop and improve program policies and procedures
maintain the health plan codebook
ensure accurate application of medical coding standards
recommend improvements to processes and benefit plans based on industry best practices
interface and collaborate with clinicians, medical administrators, federal staff, contract staff, and occupational health subject matter experts

Requirements

What you’ll need

A bachelor’s or master’s degree in a health profession (HIM, MPH, MHA, RN, PA)
A minimum of 5 years’ experience working with health insurance payor claims data in a health plan or managed care setting
Experience in healthcare quality, medical coding, and claims auditing
Demonstrated expertise in CPT, HCPC and ICD billing codes
Proficient in Microsoft Office Suites, including Excel, Outlook, and SharePoint
Registered health information administrator (RHIA), Registered Health Information Technician (RHIT) or Certified Coding Specialist (CCS) certification desirable

Benefits

Comp & perks

paid leave
options for employer sponsored group medical
dental
vision
short-term and long-term disability
life insurance
AD&D coverage
legal services
identity theft
accident insurance
flexible spending account
health saving account options
401(k) retirement plan with employer contribution match
professional growth through professional courses
certifications
tuition reimbursement programs