Claim Review Specialist (CCS, COC, CPC)

Job Summary

A company is looking for a Claim Review Specialist (CCS, COC, CPC required).

Key Responsibilities

• Assist in preparing claim audits and reviewing coding changes on outpatient and Profee claims
• Audit medical record entries and coding accuracy, providing recommendations for documentation improvement
• Develop standardized reports and participate in client presentations and education

Required Qualifications

• 5+ years of claims auditing/review experience
• CCS, COC, or CPC certification required
• Experience with outpatient and Profee coding, including infusion/injection coding
• Proficient with Microsoft Office and various EMR systems
• Strong understanding of CMS guidelines and Medicare claims processing