Certified Coding Specialist

Job Summary

To support a growing team, the remote full-time Senior Manager, Medical and Payment Policy Performance Research and Correct Coding Analysis will independently manage policy and coding reviews, ensuring compliance with medical and pre-payment policies while collaborating with cross-functional teams to optimize claims processing.

Key Responsibilities

• Collaborate with IT, compliance, operations, and provider relations to integrate claims coding changes and resolve configuration issues
• Monitor claims coding accuracy and trends, providing actionable insights for process improvement
• Evaluate end-to-end workflows and translate findings into actionable policy and coding guidance

Required Qualifications

• 5+ years of experience in healthcare claims administration, coding, or configuration
• Proven expertise in configuration testing and process optimization for medical and pre-payment policy
• Proficiency with claims adjudication platforms and data analysis applications
• Bachelor's degree in Healthcare Administration, Information Systems, Business, or equivalent experience
• Certified Coding Specialist required