Certified Claim Review Specialist

Job Summary

To support the revenue cycle consulting team, the full-time remote Certified Claim Review Specialist will assist in preparing claim audits, reviewing coding, and providing client education on hospital outpatient and Profee claims using proprietary software.

Key responsibilities:

• Audit claims for accuracy, including charges and compliance with CMS and payer guidelines
• Develop standardized reports and respond to coding inquiries from clients
• Prepare written documentation and participate in client presentations over web meetings

Required qualifications:

• Coding certification through AHIMA or AAPC (CCS, COC, or CPC required)
• 5+ years of experience in outpatient facility coding, including specific knowledge of ER, SDS, and E/M coding
• Strong understanding of revenue cycle processes and Official Coding Guidelines
• Proficiency in Microsoft Excel, PowerPoint, Word, and OneNote
• Knowledge of medical terminology and anatomy is required; inpatient coding experience is preferred