Claritev is a dynamic healthcare company committed to innovation and service excellence in bending the cost curve in healthcare.
The Senior Medical Coding Specialist analyzes the highest dollar and most complex claims applying coding standards, research, industry knowledge, and federal regulations to ensure accurate billing. This role reviews inpatient, outpatient, and practitioner billing, considering diagnoses, procedures, and international healthcare standards.
Responsibilities include:
- Reviewing and analyzing complex billing for medical appropriateness
- Assisting management with daily department operations
- Designing and delivering training for coders, negotiators, and physicians incorporating international coding systems (e.g., ICD-10-AM, OPCS-4, SNOMED CT)
- Leading claim completion meetings and coding protocol development
- Providing SME support to clinical teams
- Monitoring turnaround times and suggesting process improvements
- Applying national and international coding standards and regulations
- Researching claims and collaborating to develop coding edits and guidelines
- Communicating findings clearly to coworkers and management
- Evaluating and mentoring staff
- Ensuring compliance with HIPAA and international data protection regulations (GDPR, PIPEDA)
Job scope requires independent work with minimal supervision on varied and complex projects.
Compensation: $70,000-$90,000 annually plus health insurance, 401(k), and bonus opportunities.
Requirements:
- Current coding certification through AHIMA or AAPC, or medical license (RN or MD)
- 7+ years clinical experience (coding, auditing, nursing, radiology, laboratory, pharmacy, or physician assistant roles)
- Extensive knowledge of inpatient and outpatient hospital billing, CPT, HCPCS, ICD-10, DRG, APCs, and international coding equivalents
- Knowledge of payer reimbursement policies, federal regulations, medical necessity criteria
- Auditing and health information management experience preferred
- Proficiency with Microsoft Office; experience with international billing platforms a plus
- Strong communication, analytical, organizational, and teaching skills
- Ability to work evenings/weekends to meet deadlines
- Ability to read and abstract medical records
- Leadership and mentoring abilities
Benefits include medical, dental, vision coverage, life insurance, disability benefits, paid parental leave, 401(k) plan with match, employee stock purchase, generous PTO, paid holidays, tuition reimbursement, flexible spending account, employee assistance program, and sick time benefits.
Claritev is an Equal Opportunity Employer.
- Current coding certification through AHIMA or AAPC, or medical license such as RN or MD
- Minimum 7 years clinical experience in coding, auditing, nursing, radiology, laboratory, pharmacy, or physician assistant roles
- Extensive knowledge of inpatient and outpatient billing systems and coding standards including international equivalents
- Understanding of payer reimbursement policies and federal/state regulations
- Experience in auditing and health information management preferred
- Proficiency with Microsoft Office; familiarity with international billing systems a plus
- Strong communication, analytical, organizational, problem-solving, and time management skills
- Ability to develop educational tools and job aids
- Willingness to work additional hours as needed to meet deadlines
- Ability to read and abstract medical records
- Leadership, teaching, and mentoring skills
- Ability to work in a standard office environment for extended periods
- Medical, dental, and vision insurance with low deductibles and copays
- Life insurance
- Short and long-term disability
- Paid parental leave
- 401(k) plan with company match
- Employee stock purchase plan
- Generous paid time off accrued by years of service
- 10 paid company holidays
- Tuition reimbursement
- Flexible spending account
- Employee assistance program
- Sick time benefits as per state laws
Location
N/A
Employment Type
Full-time
Experience Level
Senior
Salary Range
$70,000 - $90,000
Remote work allowed
No
Posted
1 month ago