Certified Claim Review Specialist

Job Summary

Working remotely in a full-time capacity, the Certified Claim Review Specialist will assist in preparing claim audits, reviewing and recommending coding changes, and providing client support using proprietary software.

Key responsibilities

• Audit outpatient claims for accuracy, including coding compliance and adherence to CMS guidelines
• Develop standardized reports and assist in client education through clear communication and documentation
• Utilize proprietary software to analyze claims data and identify trends for review

Required qualifications

• Coding certification through AHIMA or AAPC (CCS, COC, or CPC required)
• Minimum of 5 years of experience in outpatient facility coding, including ED, SDS, and E/M
• Strong knowledge of revenue cycle processes and outpatient coding guidelines
• Proficiency in Microsoft Excel, PowerPoint, Word, and OneNote
• Familiarity with clinical documentation and inpatient coding is preferred