C&S Clinical Coding Analyst

About Our Client:
The organization operates globally in the healthcare sector, utilizing technology to improve health outcomes by connecting individuals with care, pharmacy benefits, data, and resources. It focuses on advancing health optimization and serving communities at scale.
About the Opportunity:
The C&S CLINICAL CODING ANALYST role involves ensuring the accuracy of provider claims by reviewing medical records and applying coding and compliance guidelines. This position impacts the organization by supporting accurate payment decisions, identifying billing irregularities, and maintaining compliance in a production-driven environment.
Responsibilities:
Perform quality audits of clinical review cases involving CPT, HCPCS, and modifiers
Assess accuracy of medical coding, billing, and payment recommendations for pre-payment claims
Interpret state and federal mandates, benefit language, and reimbursement policies
Determine appropriate level of service using Evaluation and Management coding principles
Ensure compliance with state, federal, and contract policies
Identify aberrant billing patterns, potential fraud, waste, or abuse
Manage daily case review assignments meeting quality and productivity standards
Provide clinical expertise to investigative and analytical teams
Participate in team and department meetings
Work collaboratively and independently as needed
Serve as a clinical resource within the investigative team
Collaborate with business partners to obtain information relevant to clinical reviews
Requirements:
High School Diploma or GED
AHIMA or AAPC Certified coder (CPC, CCS, CCS-P)
Minimum 2 years as certified coder with experience in CPT/HCPCS/ICD/Modifiers – 10/CM/PCS coding
At least 2 years working with health insurance terminology and regulatory guidelines
Minimum 1 year in a team environment with metric-driven daily production and quality standards
Intermediate experience in medical record review
Intermediate computer skills with problem-solving ability
Proficiency in Microsoft and Adobe applications (Outlook, PowerPoint, Word, Excel, PDF)
Preferred Qualifications:
Bachelor’s degree
Healthcare claims or processing experience
Strong communication and data interpretation skills
Experience with Fraud, Waste & Abuse or Payment Integrity
Experience with subsequent or reconsideration reviews for FWAE
Analytical skills with medical terminology and coding
Pay Range and Compensation Package:
The hourly pay for this role ranges from $24.00 to $43.00 based on full-time employment, education, experience, certifications, and local labor markets.
Benefits include a comprehensive package, incentive programs, equity stock purchase, and 401(k) contributions, subject to eligibility.
Benefits & Perks:
401(k)
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