Senior Medical Coding Specialist

The Senior Medical Coding Specialist at Claritev is responsible for analyzing complex high-dollar claims using advanced coding knowledge, research, and regulatory standards to ensure accurate billing. This role focuses on Workers’ Compensation claims and applies U.S. and international coding standards. Key duties include reviewing inpatient, outpatient, and practitioner claims for medical appropriateness and billing accuracy; evaluating charges across revenue centers; supporting operations with leadership; leading claim review discussions; designing and delivering coding education; serving as a subject matter expert; monitoring turnaround times; researching claims and documentation; collaborating to enhance coding guidelines; communicating findings; evaluating team performance; contributing to process improvements; and ensuring HIPAA compliance.

Requirements:

• Minimum 2+ years Workers’ Compensation coding experience
• Current AHIMA or AAPC coding certification or active RN/MD license
• 7+ years clinical experience in coding, auditing, nursing, radiology, laboratory, pharmacy, or physician assistant roles
• Extensive knowledge of inpatient/outpatient billing including UB-04, revenue codes, CPT, HCPCS, ICD-10, DRG, APCs
• Familiar with international coding systems preferred
• Strong understanding of reimbursement policies, medical necessity, and regulations
• Experience with auditing and health information management preferred
• Proficient with Microsoft Office
• Strong analytical, decision-making, communication, and multitasking skills
• Ability to develop training materials and work independently
• Flexibility for evening/weekend hours as needed

Benefits include medical, dental, vision, life insurance, disability, paid parental leave, 401(k) with match, employee stock purchase plan, paid time off, holidays, tuition reimbursement, flexible spending account, and employee assistance programs.