Certified Claim Review Specialist

Job Summary

A company is looking for a Claim Review Specialist to assist in preparing claim audits and providing support for revenue cycle consulting.

Key Responsibilities

• Assist in preparing claim audits and reviewing coding and billing changes for outpatient and Profee claims
• Develop standardized reports and respond to coding questions while providing client education
• Audit claims for accuracy, ensuring compliance with CMS and payer-specific guidelines

Required Qualifications

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