State Licensed Biller/Coder

Job Summary

To support continuous monitoring of medical and pharmacy claims, the part-time State Licensed Biller/Coder will review claims for coding accuracy and reimbursement appropriateness, develop alert and trigger logic for high-risk claims, and collaborate with stakeholders, all while working remotely for approximately 5-8 hours per week with flexible scheduling.

Key responsibilities

• Review medical and pharmacy claims to validate coding accuracy and reimbursement appropriateness
• Develop and maintain trigger logic to identify high-risk or outlier claims
• Document findings and collaborate with claims specialists and clinical stakeholders to ensure actionable outcomes

Required qualifications

• Active billing/coding credential such as CPC, CCS, CCS-P, RHIA, RHIT, or equivalent
• 3+ years of experience in medical billing, coding, or claims review
• Experience with payment integrity, audits, or overpayment recovery is preferred
• Familiarity with high-cost claims and specialty drug billing
• Experience in designing rules, edits, or analytics-driven claim flags is preferred