Claims Editing Specialist

Job Summary

Seeking a remote Content Innovation, Claims Editing Specialist focused on specialty pharmacy, this full-time role will source, design, validate, and maintain clinical and coding content for editing products, ensuring accuracy in healthcare payments related to high-cost drugs.

Key responsibilities

• Source and author editing content by interpreting authoritative coding and clinical guidelines
• Monitor specialty pharmacy drug information and maintain edits for billing and dosing
• Validate content using claims data to measure accuracy and effectiveness of edits

Required qualifications

• 7+ years of experience in claims editing, clinical coding, or payer policy
• Active coding credential (e.g., CPC, CCS) or a clinical license with coding experience
• Deep knowledge of CPT, HCPCS, ICD-10-CM, and reimbursement methodologies
• Experience with claims data analysis using SQL, Excel, or similar tools
• At least 3 years of experience with medical benefit drug billing and coding