Washington State Licensed Coding Specialist

Job Summary

A company is looking for a Sr Claims Reimbursement and Coding Specialist.

Key Responsibilities:

• Conducts complex claim audits and analyzes claims data to ensure compliance with regulatory requirements
• Collaborates with regulatory authorities and prepares education materials for external provider partners
• Identifies and recommends interventions for improper payments and supports system configuration activities

Required Qualifications, Training, and Education:

• Minimum of 5+ years of medical coding/auditing experience, including at least 1 year in fraud, waste, and abuse
• Coding certification such as CPC or CCS is required
• Expert knowledge of ICD-10, CPT, HCPC, and CDT coding
• Knowledge of Medicare and Medicaid guidelines
• Ability to review large data sets and manage multiple cases of varying complexity