Senior Specialist, Coding (Remote)

1. About Our Client:
The organization operates within the healthcare payment integrity sector, focusing on ensuring correct coding and accurate claim edits to support cost savings and compliance. It collaborates with Health Plans, vendors, and internal teams to maintain coding accuracy and operational integrity across payment processes.
2. About the Opportunity:
The Senior Specialist, Coding plays a key role in the Payment Integrity Prepay operations by researching and validating coding edit inquiries and outcomes. This position helps maintain savings accuracy by monitoring trends and ensuring consistent application of coding guidelines, contributing to reliable claim processing and financial integrity.
3. Responsibilities:
Serve as the subject matter expert and primary contact for assigned states, Health Plans, or edit categories.
Research and analyze coding edit accuracy and savings outcomes.
Apply relevant state, federal, industry, and vendor coding guidelines.
Review edit outcomes to identify inconsistencies, risks, and improvement opportunities.
Monitor coding trends and savings indicators to detect variations.
Support triage and resolution of coding edit inquiries.
Assist in resolving coding and savings questions and escalations.
Collaborate with prepay editing vendors and internal stakeholders on coding inquiries.
Communicate coding insights and findings to internal teams and Health Plan partners.
Recommend improvements for coding consistency and edit accuracy.
Support creation of job aids, training materials, and guidance on coding accuracy.
Utilize subject matter expertise to support coding edit processes and initiatives.
4. Requirements:
Associate’s Degree or equivalent experience.
3–5+ years of experience in coding, payment integrity, or healthcare claims.
Experience with coding accuracy, edit review, savings analysis, and workflows.
Active and unrestricted coding certification such as CPC, CCS, CCS-P, RHIT, or equivalent.
Preferred Qualifications:
Bachelor’s Degree in Business, Healthcare, or related field.
Experience with prepayment coding programs and payer environments.
Familiarity with coding vendors and Health Plan partners.
Knowledge of state-specific coding and reimbursement guidelines.
Proficiency in Excel for tracking and reporting.
5. Pay Range and Compensation Package:
The pay range and compensation package for this role will be determined based on the candidate’s experience, skills, and other relevant factors.
Equal Opportunity Statement: Our client is an equal opportunity employer. They celebrate diversity and are committed to creating an inclusive environment for all employees. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, or national origin.
Note:
RemoteHunter is a recruitment partner of this role. Please note that all employment decisions, including candidate assessment, interviews, hiring, compensation, and employment terms, are made exclusively by the hiring employer.

Work arrangement
Yes