New York Medicaid Claims Editor

Job Summary

To support the development of innovative claims editing content, the remote New York Medicaid Claims Editor will source, design, validate, and maintain clinical and coding content while leveraging deep expertise in New York State Medicaid policies and reimbursement methodologies.

Key responsibilities

• Source and author editing content by interpreting authoritative coding and reimbursement guidelines
• Monitor New York Medicaid sources to ensure content accuracy and compliance with state policies
• Utilize claims data to validate editing concepts and measure their impact on client outcomes

Required qualifications

• 7+ years of experience in claims editing, clinical coding, or payer policy
• Active coding credential (CPC, CCS, etc.) or a clinical license (e.g., RN) with coding experience
• In-depth knowledge of CPT, HCPCS, ICD-10-CM, and reimbursement methodologies
• Experience with New York State Medicaid policies and billing practices
• Strong analytical skills and proficiency in SQL, Excel, or similar tools for data analysis