Certified Medical Coder

Job Summary

A company is looking for a Certified Medical Coding Specialist.

Key Responsibilities

• Support claim accuracy by managing pre-pay and post-pay workflows, including claim editing and recovery processes
• Help define and validate claim edit logic and payment integrity rules to ensure proper functionality
• Conduct medical coding audits and assist with customer appeals by reviewing billed services against policies and coding guidelines

Required Qualifications

• 2+ years of experience in healthcare claims, provider billing, or health plan payment integrity
• 1+ years as a certified medical coder in a payer, provider, or RCM environment
• Bachelor's degree in Healthcare Administration, Business, or a related field (or equivalent experience)
• Active medical coding credentials required (CPC, CCS, or CCA)
• Working knowledge of Medicare, Medicaid, and Commercial payer regulations