Certified Medical Coding Specialist
Core
Validate edit logic and conduct medical coding audits to improve claim payment accuracy and reduce waste for insurance customers.
Role type
Senior IC medical coding specialist (payment integrity)
Builds
Claim payment integrity solutions and edit logic for insurers
Domain
Healthcare insurance / Medical coding
Deliverable
production ML models
Required skills
Medical coding (ICD, CPT, HCPCS, DRG), Claim auditing, Payer policy research, Data analysis, UAT support, Documentation
Preferred skills
Medicare/Medicaid/Commercial payer regulations knowledge, Trend identification
Technologies
ICD, CPT, HCPCS, DRG
Responsibilities
Validate claim edit logic and payment integrity rules; Perform medical coding audits (inpatient, outpatient, professional); Support customer appeals process; Monitor payer policies to identify gaps; Partner with Product/Engineering for testing and UAT; Maintain audit documentation.
Seniority
Mid-Senior, hands-on IC
