Leads the Code Edit Analyst team and provides operational oversight, technical expertise, and subject matter guidance for claims coding review and compliance. Ensures consistent, compliant, and efficient processing of medical necessity and code edit work while supporting revenue integrity initiatives.
The role performs advanced coding reviews, monitors trends in denials and coding edits, and collaborates with Billing, Coding, Clinical, CDI, Compliance, and Revenue Cycle leadership to improve accuracy, reduce denials, and strengthen workflow performance.
Remote role based out of Greenville, NC. Monday through Friday, full-time day shift.
• Bachelor's degree in a related discipline, or more than five years of extensive experience with an intermediate auditing background plus a coding certificate in lieu of degree. • CCS, CPC, RHIT, or equivalent certification required. • Leadership, mentoring, or training experience preferred. • Strong knowledge of CMS payment systems, reimbursement methodologies, HIPAA, and privacy requirements. • Experience with hospital information systems and claims platforms; Epic preferred. • Advanced knowledge of ICD-10, CPT, HCPCS, UB-04/837, and 1500 claim forms. • Ability to interpret payer regulations, CMS guidance, and coding policies. • Strong analytical, communication, presentation, and interpersonal skills. • Knowledge of medical terminology, anatomy, and physiology. • Ability to perform complex medical record review, auditing, and trend analysis.
• Great benefits • Remote work opportunity • Full-time weekday schedule • Day shift with training hours of 8:00 a.m. to 4:30 p.m.
Location
North Carolina, US
Employment Type
Full-time
Experience Level
Senior
Remote work allowed
Yes
Posted
4 weeks ago