At Claritev, we pride ourselves on being a dynamic team of innovative professionals focused on reducing healthcare costs through technology, data, and innovation. The Medical Coding Specialist role involves billing analysis of claims, applying coding standards and federal regulations for accurate billing, and monitoring patient bills for quality and compliance.
Key duties include reviewing inpatient, outpatient, and provider billing, applying national and international coding standards (e.g., ICD-10-AM, OPCS-4, SNOMED CT), preparing documentation for audits and compliance reviews, researching claims and medical records, assisting with claim review recommendations, educating staff on clinical and reimbursement matters, monitoring trends and regulatory changes globally, ensuring compliance with HIPAA and international data protection laws, and collaborating across teams.
This role requires independent work with general supervision, managing multiple complex projects, and adherence to company business principles and industry trends. It is considered a high-risk role due to exposure to sensitive PHI data.
- Minimum medical license or coding certification; Bachelor's degree preferred or healthcare-related degree with at least 2 years coding experience.
- Current nursing or coding certifications (CCS, CCS-P, CPC), or RHIA/RHIT.
- Minimum 2 years of direct patient care, medical billing, insurance auditing, line item review, audits, coding, or reimbursement experience.
- Knowledge of inpatient/outpatient hospital billing (UB-04s, revenue codes, CPT, HCPCS, ICD-9/10, DRG, APCs) and international equivalents (KSA, ICD-10-AM, ACHI, CCI).
- Knowledge of professional claim billing requirements and international claim forms.
- Familiarity with payer policies, federal/state regulations, global medical necessity criteria, and international medical data resources.
- Auditing and health information management experience preferred.
- Excellent communication, teamwork, training, negotiation, and organizational skills including cross-cultural communication.
- Proficiency in MS Office and databases; experience with international billing platforms a plus.
- Ability to multitask in a fast-paced environment and abstract medical records.
- Knowledge of medical terminology, anatomy, and physiology.
- Ability to discuss audit results with providers.
- Required certifications and ability to work in a standard office environment.
- Medical, dental, and vision coverage with low deductibles and copays
- Life insurance
- Short and long-term disability
- Paid parental leave
- 401(k) with company match
- Employee stock purchase plan
- Generous paid time off accruing with years of service
- Paid company holidays
- Tuition reimbursement
- Flexible spending account
- Employee assistance program
- Sick time accrual in accordance with state laws
- Flexible schedules and professional development opportunities
Location
N/A
Employment Type
Full-time
Experience Level
Associate
Salary Range
$60,000 - $63,000
Remote work allowed
Yes
Posted
3 weeks ago