Medical Coding Specialist

Medical Coding Specialist

Company: Claritev
Location: Not Specified
Salary Range: $60,000 – $63,000

At Claritev, we pride ourselves on being a dynamic team of innovative professionals dedicated to bending the cost curve in healthcare. We are intentionally bold, foster innovation, nurture accountability, champion diversity, and empower each other. Join our transformational journey to become a leading voice in healthcare technology, data, and innovation.

Job Summary

The Medical Coding Specialist is responsible for providing billing analysis of claims and applying coding standards and federal regulations to ensure correct billing practices. You will perform bill and chart reviews to identify variations from quality billing practices and monitor patient bills for accuracy and compliance. This role requires awareness of international coding systems and healthcare billing practices to support global operations and ensure alignment with international regulatory standards.

Duties

• Review and analyze inpatient, outpatient, and provider billing for medical appropriateness of treatment; analyze charges across various revenue centers with consideration to patient diagnosis, procedures, age, facility type, and international healthcare norms where applicable.
• Apply recommendations of national coding and international coding and regulation standards (e.g., ICD-10-AM, OPCS-4, SNOMED CT) to claims billed.
• Prepare clear, concise, and legible findings, including documentation that may be used in cross-border audits or international compliance reviews.
• Research, review, and provide internal responses based on receipt of itemized bills, claims, operative notes, and other documentation, including those from international providers or translated medical records.
• Assist with, create, or enhance internal claim and review recommendations.
• Communicate with co-workers and management regarding clinical and reimbursement findings.
• Assist with clinical education of staff as it relates to clinical aspects of claims, suggesting additional negotiation talking points or tools, and communicating overall industry or regulatory changes which affect the department.
• Monitor, research, and summarize trends, coding practices, and regulatory changes across multiple countries or regions.
• Research and review individual claims, claim trends, or detailed itemized bills, operative notes, and other documentation as needed.
• Collaborate, coordinate, and communicate across disciplines and departments.
• Ensure compliance with HIPAA and international data protection regulations (e.g., GDPR, PIPEDA).
• Demonstrate commitment to the Company's core values.
• This position is considered a High Risk Role due to exposure to PHI sensitive data.

Job Scope

This position works independently with general supervision. The incumbent balances several projects at a time, and work is varied and complex. Complex issues are referred up to higher levels. The incumbent will use established procedures and knowledge of the Company's general business principles, industry dynamics, market trends, and specific operational details when performing all aspects of the job.

Compensation

• Salary Range: $60,000 – $63,000
• Specific offers consider candidate's education, experience, skills, work location, and internal equity.
• Eligible for health insurance, 401k, and bonus opportunity.

Qualifications

Requirements:

• Minimum completion of educational curriculum required for medical license or coding certification, with a Bachelor's Degree preferred; OR minimum Bachelor's Degree in a healthcare-related field and at least 2 years of coding experience.
• Current nursing certification and/or current certified coder (CCS, CCS-P or CPC), Registered Health Information Technician (RHIA/RHIT).
• Minimum 2 years of experience in direct patient care, medical procedure billing, medical insurance auditing, line item review, audits, coding, and/or reimbursement.
• Knowledge of inpatient/outpatient hospital billing requirements including UB-04s, revenue codes, CPT, HCPCS, ICD-9/10, DRG, APCs, and familiarity with international equivalents (e.g., KSA, ICD-10-AM, ACHI, CCI).
• Knowledge of professional claim billing requirements including HCFA-1500s, CPT codes and ICD-9/ICD-10 diagnoses codes, as well as international claim forms.
• Knowledge of payer reimbursement policies, state and federal regulations, international healthcare systems, and global medical necessity criteria.
• Familiarity with international medical data resources and coding tools.
• Auditing and health information management experience in a healthcare setting preferred.
• Excellent communication (verbal and written), teamwork, training, presentation, negotiation, and organizational skills, including cross-cultural communication.
• Proficiency in MS Office Suite and database software; experience with international billing platforms is a plus.
• Ability to handle multiple tasks in a fast-paced environment.
• Ability to read and abstract medical records.
• Knowledge of medical terminology, anatomy, and physiology.
• Ability to interact and discuss audit results with providers.
• Required licensures, professional certifications, and/or Board certifications as applicable.
• Ability to work in a standard office environment requiring sitting and viewing monitors for extended periods, operating standard office equipment.

Benefits

• Competitive compensation and benefits packages.
• Incentive bonus program, recognition, and awards programs.
• Friendly and supportive work environment.
• Flexible schedules whenever possible.
• Wide range of live and web-based professional development and educational programs.

Your Benefits Will Include:

• Medical, dental, and vision coverage with low deductible & copay.
• Life insurance.
• Short and long-term disability.
• Paid Parental Leave.
• 401(k) + match.
• Employee Stock Purchase Plan.
• Generous Paid Time Off (accrued based on years of service).
• 10 paid company holidays.
• Tuition reimbursement.
• Flexible Spending Account.
• Employee Assistance Program.
• Sick time benefits (accrual rates may vary by state law).

EEO Statement

Claritev is an Equal Opportunity Employer and complies with all applicable laws and regulations.