Claims Examiner

Firstsource; United States; Hybrid; USD 43,000 - 52,000; Full time

Job summary

Firstsource in Puerto Rico is seeking an experienced Certified Professional Coder (CPC) to support medical record reviews and coding validation for U.S. healthcare clients.

The role involves reviewing documentation for claim disputes and ensuring codes comply with ICD-10-CM, CPT, HCPCS, CMS, HIPAA, and payer guidelines. The position requires bilingual English/Spanish and a commitment to accuracy and confidentiality.

Qualifications

• Certification CPC or CCS/CCA from AAPC/AHIMA.
• Minimum 2 years professional medical coding experience.
• Call center experience required.
• Experience with US healthcare reimbursement, medical record review, and various payers.
• Proficient in ICD-10-CM, CPT, HCPCS, medical terminology, anatomy & physiology, and EHR systems.
• Associate degree in HIM, Medical Coding, or related field.
• Excellent verbal and written communication; bilingual English/Spanish.
• Availability for rotating 8-hour shifts; Mon-Fri 8:00 a.m.–11:00 p.m.; weekends/holidays may be required.

Responsibilities

• Review medical records and validate diagnosis and procedure codes.
• Ensure coding complies with ICD-10-CM, CPT, HCPCS, CMS, HIPAA, and payer guidelines.
• Review claim denials, appeals, audits, and coding disputes; identify opportunities for more specific diagnosis coding.
• Document coding decisions and collaborate with providers and operations staff.
• Maintain coding accuracy, productivity, and confidentiality of PHI.

Skills

Medical coding

Bilingual (English/Spanish)

Verbal and written communication

MS Office proficient

Education

Associate degree in Health Information Management

Tools

ICD-10-CM

CPT

HCPCS

EHR systems (Epic, MEDITECH, eClinicalWorks, 3M Encoder)

Microsoft Office

Job description

We are seeking an experienced Certified Professional Coder (CPC) to support medical record reviews and coding validation activities for U.S. healthcare clients.

This position will play a critical role in reviewing medical documentation associated with claim disputes and determining whether diagnosis codes submitted by providers are appropriate, sufficiently specific, and compliant with applicable coding guidelines.

Key Responsibilities

Review medical records and validate diagnosis and procedure codes.

Ensure coding complies with ICD-10-CM, CPT, HCPCS, CMS, HIPAA, and payer guidelines.

Review claim denials, appeals, audits, and coding disputes.Identify opportunities for more specific diagnosis coding when documentation supports it.

Document coding decisions and collaborate with providers and operations staff.

Maintain coding accuracy, productivity, and confidentiality of PHI.

Qualifications

One of the following certifications: AAPC: CPC / AHIMA: CCS or CCA

At least 2 years of professional medical coding experience.

Call center experience (required).

Experience with: U.S. healthcare reimbursement ; Medical record review ; Medicare, Medicaid, commercial insurance, or managed care ; Clinical documentation review

Proficiency with: ICD-10-CM ; CPT ; HCPCS ; Medical terminology ; Anatomy and physiology ; EHR systems (such as Epic, MEDITECH, eClinicalWorks, 3M Encoder);

Microsoft OfficeExperience with claim denials, appeals, audits, or coding validation.Managed Care or Medicaid coding experience.Associate degree in Health Information Management, Medical Coding, Healthcare Administration, or a related field (or equivalent experience).

Excellent verbal, written, reading, and presentation skills.

Fully bilingual in English and Spanish (required).Intermediate to advanced proficiency in computer applications and Microsoft Office

Availability to work rotating eight (8)-hour shifts in a Monday through Friday operation between 8:00 a.m. and 11:00 p.m. Occasional availability to work weekends and holidays may be required based on operational needs.

Benefits

• Opportunities for professional growth and career development.
• Leadership and training programs.
• Paid time off.
• Retirement plan.
• The opportunity to be part of a global organization committed to excellence and innovation.

Location:On-site in Guaynabo, Puerto Rico | Hybrid work arrangement available, subject to performance evaluations and operational needs.

Employment Type:Full-Time

Compensation:Starting$21.00 per hour

We are an Equal Employment Opportunity (EEO) employer committed to fostering a diverse and inclusive workplace.