Medical Coding Specialist

Medical Coding Specialist

Claritev is a dynamic team of innovative professionals dedicated to bending the cost curve in healthcare. We are committed to service excellence, consistently exceeding expectations for all our stakeholders. Our culture is built on boldness, innovation, accountability, diversity, and empowering each other to reach our collective potential. Join us on our transformational journey as we optimize opportunities to become a leading voice in healthcare technology, data, and innovation.

About the Role

The Medical Coding Specialist is responsible for performing billing analysis of claims, applying coding standards, and ensuring compliance with federal regulations for correct billing practices. You will conduct bill and chart reviews to identify deviations from quality billing practices and monitor patient bills for accuracy and compliance. This role also requires an understanding of international coding systems and healthcare billing practices to support global operations and ensure alignment with international regulatory standards.

Key Responsibilities

• Review and analyze inpatient, outpatient, and provider billing for medical appropriateness, considering patient diagnosis, procedures, age, facility type, and international healthcare norms.
• Apply national and international coding and regulation standards (e.g., ICD-10-AM, OPCS-4, SNOMED CT) to claims.
• Prepare clear and concise findings, including documentation for cross-border audits or international compliance reviews.
• Research, review, and provide internal responses based on itemized bills, claims, operative notes, and other documentation, including those from international providers or translated medical records.
• Assist in creating or enhancing internal claim and review recommendations.
• Communicate clinical and reimbursement findings to colleagues and management.
• Assist with staff education on clinical aspects of claims, suggesting negotiation points, tools, and communicating industry or regulatory changes.
• Monitor, research, and summarize trends, coding practices, and regulatory changes across multiple countries or regions.
• Collaborate 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.

Requirements

• Completion of educational curriculum required for a medical license or coding certification, with a Bachelor's Degree preferred; OR a 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 (e.g., 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 (e.g., HCFA-1500s, CPT codes, ICD-9/10 diagnoses codes) and international claim forms.
• Understanding 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 is 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.

What We Offer

• Competitive salary range: $60,000 – $63,000 per year.
• Eligibility for health insurance, 401(k) with match, and bonus opportunities.
• Medical, dental, and vision coverage with low deductibles and copays.
• Life insurance, short-term and long-term disability.
• Paid Parental Leave.
• Employee Stock Purchase Plan.
• Generous Paid Time Off.
• 10 paid company holidays.
• Tuition reimbursement.
• Flexible Spending Account.
• Employee Assistance Program.
• Sick time benefits (as per state law or company policy).
• A friendly and supportive work environment.
• Flexible schedules where possible.
• A wide range of professional development and educational programs for advancement opportunities.

This is a permanent