Certified Medical Coding Specialist
Shift Technology
full-time
Posted on:
Location Type: Remote
Location: Massachusetts • United States
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Salary
💰 $55,000 - $65,000 per year
About the role
- Assist in managing pre-pay and post-pay workflows, including claim editing and recovery processes.
- Help define and validate claim edit logic and payment integrity rules to ensure they are functioning correctly for customers.
- Perform medical coding audits (inpatient, outpatient, professional) by validating ICD, CPT, HCPCS, and DRG codes under the guidance of senior staff.
- Support the customer appeals process by reviewing billed services and assessing their alignment with policies and coding guidelines.
- Monitor payer policies and industry benchmarks to identify potential gaps in the current edit library and suggest improvements.
- Partner with Product and Engineering teams to assist in testing, troubleshooting, and User Acceptance Testing (UAT) for new and updated rules.
- Maintain clear documentation of audit findings and project progress for internal and external stakeholders.
Requirements
- 2+ years of experience in healthcare claims, provider billing, or health plan payment integrity.
- 1+ years as a certified medical coder in a payer, provider, or RCM environment.
- Working knowledge of Medicare, Medicaid, and Commercial payer regulations.
- Proficiency in auditing for coding accuracy (ICD, CPT, HCPCS, modifiers).
- Ability to review data and identify trends or inconsistencies that impact claim accuracy.
- Strong written and verbal skills; ability to explain technical coding findings clearly to team members.
- Ready to learn and grow in a fast-paced environment while managing multiple tasks effectively.
Benefits
- Flexible remote and hybrid working options
- Competitive Salary and a variable component tied to personal and company performance
- Multiple Learning and Development opportunities, including Focus Fridays, a half-day each month to focus on learning and personal growth
- Generous PTO and paid holidays
- Mental health benefits
- 2 MAD Days per year (Make A Difference Days for paid volunteering)
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
medical codingICD codesCPT codesHCPCS codesDRG codesclaim editingpayment integrityauditingdata analysisUser Acceptance Testing
Soft Skills
strong written communicationstrong verbal communicationability to explain technical findingsability to identify trendsability to manage multiple taskswillingness to learnadaptability
Certifications
certified medical coder