At Claritev, we pride ourselves on being a dynamic team of innovative professionals focused on bending the cost curve in healthcare. The Senior Medical Coding Specialist analyzes the highest dollar and most complex claims applying research, coding standards, industry knowledge, and federal regulations to ensure accurate billing practices, including for international standards.
Responsibilities include reviewing complex inpatient, outpatient, and practitioner billing for medical appropriateness and compliance; assisting management with department operations; designing and delivering clinical and coding education incorporating international coding systems; facilitating coding operations meetings; applying coding standards; researching claims; collaborating with physicians and analytics teams; monitoring trends and regulatory changes; and mentoring staff. The role requires handling sensitive protected health information (PHI) and may require work beyond regular hours to meet deadlines.
This position operates independently with minimal supervision, managing multiple complex projects with referrals for more complex issues.
Compensation ranges from $70,000 to $90,000 annually, with eligibility for health insurance, 401k, and bonuses.
- Current coding certification through AHIMA or AAPC, or a medical license (RN or MD)
- 7+ years of experience in clinical fields including coding, auditing, nursing, radiology, lab, pharmacy, or physician assistant roles
- Extensive knowledge of inpatient/outpatient hospital billing, claims data, and coding systems (e.g., UB-04, CPT, HCPCS, ICD-10, DRG, APCs) and international equivalents (KSA, ICD-10-AM, ACHI, CCI)
- Familiarity with payer reimbursement policies, regulations, medical necessity criteria, and industry standards
- Auditing and health information management experience preferred
- Proficient in Microsoft Office Suite; experience with international billing platforms a plus
- Excellent communication, organizational, analytical, and multitasking skills
- Ability to develop educational materials and work evening/weekend hours if needed
- Strong clinical judgment and ability to read and abstract medical records
- Ability to lead and mentor within a learning environment
- Must be able to work in standard office conditions
- Medical, dental, and vision coverage with low deductible and copay
- Life insurance
- Short and long-term disability
- Paid parental leave
- 401(k) with match
- Employee Stock Purchase Plan
- Generous paid time off accrued by years of service
- Ten paid company holidays
- Tuition reimbursement
- Flexible Spending Account
- Employee Assistance Program
- Eligible sick time accrual based on hours worked
- Flexible scheduling and professional development opportunities
Location
N/A
Employment Type
Full-time
Experience Level
Senior
Salary Range
$70,000 - $90,000
Remote work allowed
Yes
Posted
4 weeks ago