Hybrid Senior Medical Coding & Claims Rules Architect

Judi Health, LLC; New York (NY); Hybrid; USD 70,000 - 85,000; Full time

Job summary

Judi Health, a health technology company delivering unified claims processing, is seeking a Medical Coding Specialist to configure and test medical claims rules within our platform. The role requires deep coding knowledge, healthcare operations experience, and the ability to translate client needs into scalable configurations.

You will collaborate with multiple teams to ensure accurate coding and compliant processing. New York, NY area preferred; hybrid work arrangement.

Qualifications

• Bachelor’s degree strongly preferred.
• AAPC Medical Coding & Billing Certification (e.g., CPC) required.
• 5+ years of experience with a health plan, payer, or third-party administrator (TPA).
• Strong understanding of CPT, ICD-10, HCPCS, Revenue Codes, Bill Type Codes, Place of Service Codes, and Taxonomy Codes.

Responsibilities

• Stay current on coding and coverage guidelines from CMS, AMA, AAPC, USPSTF, and other regulatory bodies.
• Utilize CPT, HCPCS, ICD-10, revenue, bill type, place of service, taxonomy, specialty, and related code sets to configure claims processing logic for commercial health plans.
• Configure, test, and maintain coding rules using internal coding and testing tools.
• Translate client requirements into accurate and timely system configurations.
• Research and resolve coding-related questions and escalations from claims processors, Customer Care, Account Management, and other stakeholders.
• Conduct regular claims reviews and audits to ensure coding accuracy, consistency, and compliance.
• Partner with Implementation, Benefit Operations, Product, and Technology teams to support new client implementations and platform enhancements.

Skills

Communication skills

Time management

Organizational skills

Team collaboration

Education

Bachelor's degree

AAPC CPC Certification

Tools

Microsoft Office Suite

SharePoint

Job description

Judi Health, a health technology company delivering unified claims processing, is seeking a Medical Coding Specialist to configure and test medical claims rules within our platform. The role requires deep coding knowledge, healthcare operations experience, and the ability to translate client needs into scalable configurations.

You will collaborate with multiple teams to ensure accurate coding and compliant processing. New York, NY area preferred; hybrid work arrangement.