Claims Editing Content Expert

Job Summary

Seeking a Claims Editing Content Expert, the remote position will source, design, validate, and maintain clinical and coding content for healthcare payment integrity, ensuring accuracy and affordability in claims editing.

Key responsibilities

• Source and author editing content from authoritative guidelines and payer policies
• Validate content using claims data to measure accuracy and client value
• Collaborate with Product and Data Science teams to develop clear content requirements and specifications

Required qualifications

• 7+ years of experience in claims editing, clinical coding, or payer policy
• Active coding credential (e.g., CPC, CCS) or clinical license (e.g., RN) with coding experience
• Deep knowledge of CPT, HCPCS, ICD-10-CM, and reimbursement methodologies
• Strong analytical skills with experience using SQL, Excel, or similar tools
• Experience collaborating with multidisciplinary teams, including Product and Engineering