Certified Claim Review Specialist

Job Summary

Supporting the Director of HIM, the full-time remote Certified Claim Review Specialist will assist in preparing claim audits, reviewing coding, and recommending changes for outpatient and Profee claims using proprietary software while providing client education and responding to coding inquiries.

Key responsibilities

• Audit claims for accuracy, including charges, coding, and compliance with CMS and payer guidelines
• Prepare standardized reports and assist in developing written materials for client education
• Participate in client presentations and maintain current knowledge of outpatient hospital reimbursement processes

Required qualifications

• 5+ years of directly related experience in revenue cycle and outpatient coding
• CCS, COC, or CPC certification is required
• Expert knowledge of medical terminology, anatomy, and coding guidelines
• Strong skills in Microsoft Excel, PowerPoint, Word, and OneNote
• Experience with clinical documentation and inpatient coding is preferred