Pennsylvania Licensed Claim Specialist

Job Summary

Collaborating with external vendors in a healthcare claims environment, the full-time Pennsylvania Licensed Claim Specialist will manage claim-edit validation, issue resolution, and performance monitoring while working remotely.

Key responsibilities:

• Acts as a liaison and resource to support internal and external strategies using national coding standards
• Determines payment compliance and researches coding issues to clarify and resolve discrepancies
• Leads the Edit Expansion Committee and coordinates vendor needs while compiling performance reports

Required qualifications:

• Minimum of 5 years of related work experience in healthcare claims or payment integrity
• High School Diploma or Equivalent (GED) required; graduate from a specialty training program preferred
• Certification as a Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) required
• Experience in Health Insurance/Managed Care preferred
• Strong knowledge of CPT, ICD-10, and HCPCS coding