Medical Coder

w3r Consulting; City of Rochester (NY); Remote; USD 30,000 - 41,000; Part time

Job summary

W3R Consulting is seeking a detail-oriented Clinical Editing Dispute Review Analyst 1 to join our healthcare operations team. The role involves researching and resolving coding-related claim disputes, reviewing provider inquiries, and ensuring accurate and timely claims processing.

Ideal candidates have experience in medical coding, claims review, clinical editing, and provider disputes. This is a 100% remote contract role based near Rochester, NY, with a six-month W-2 term and potential

Qualifications

• At least 1 year of relevant experience in medical coding, claims review, claims operations, clinical editing, or coding-related disputes.
• CPC or RHIT certification preferred.
• Knowledge of CPT, HCPCS, ICD-10-CM, CCI/NCCI edits, and medical coding conventions.
• Understanding of claims processing, adjudication, reimbursement methodologies, and claim edits.
• Proficiency in Microsoft Excel, Word, databases, and coding or claims software.
• Strong analytical, problem-solving, written communication, and organizational skills.
• Ability to manage a daily workload independently while meeting productivity and turnaround-time expectations.
• A bachelor's degree in a relevant field is preferred and may substitute for experience.

Responsibilities

• Research, triage, and resolve clinical editing and coding-related claim disputes.
• Review provider inquiries and collaborate with medical directors, claims teams, clinical reviewers, and external partners to investigate issues.
• Analyze claim edits, coding discrepancies, reimbursement rules, and claims processing issues.
• Communicate review outcomes and information requests to providers and internal stakeholders.
• Maintain accurate dispute logs, databases, and documentation.
• Monitor inquiry turnaround times, daily queues, productivity, and quality metrics.
• Support claim adjustments, provider appeals, and claims research activities.
• Identify recurring issues and recommend process improvements.

Skills

Medical coding

Claims review

Clinical editing

Provider disputes

Excel

Education

CPC or RHIT certification preferred

Bachelor's degree preferred

Tools

Microsoft Excel

Claims processing software

Job description

Clinical Editing Dispute Review Analyst 1 / Title: Medical Coder

Employment Type: Contract, W-2 | 6 Months Right to Hire

Schedule: Monday-Friday, 8-hour shifts

About the Opportunity

W3R Consulting is seeking a detail-oriented Clinical Editing Dispute Review Analyst 1 to join our healthcare operations team. This role is ideal for professionals with experience in medical coding, claims review, clinical editing, and provider dispute resolution.

The successful candidate will research and resolve coding-related claim inquiries, review clinical editing disputes, communicate findings, and help ensure accurate and timely claims processing.

Key Responsibilities

• Research, triage, and resolve clinical editing and coding-related claim disputes.
• Review provider inquiries and collaborate with medical directors, claims teams, clinical reviewers, and external partners to investigate issues.
• Analyze claim edits, coding discrepancies, reimbursement rules, and claims processing issues.
• Communicate review outcomes and information requests to providers and internal stakeholders.
• Maintain accurate dispute logs, databases, and documentation.
• Monitor inquiry turnaround times, daily queues, productivity, and quality metrics.
• Support claim adjustments, provider appeals, and claims research activities.
• Identify recurring issues and recommend process improvements.

Required Qualifications

• At least 1 year of relevant experience in medical coding, claims review, claims operations, clinical editing, or coding-related disputes.
• CPC or RHIT certification preferred.
• Knowledge of CPT, HCPCS, ICD-10-CM, CCI/NCCI edits, and medical coding conventions.
• Understanding of claims processing, adjudication, reimbursement methodologies, and claim edits.
• Proficiency in Microsoft Excel, Word, spreadsheets, databases, and coding or claims software.
• Strong analytical, problem-solving, written communication, and organizational skills.
• Ability to manage a daily workload independently while meeting productivity and turnaround-time expectations.

A bachelor's degree in a relevant field is preferred. Relevant coding, claims systems, and clinical editing experience may substitute for a degree, consistent with the position's requirements.

Preferred Qualifications

• Outpatient medical coding experience.
• Experience with provider disputes, coding denials, appeals, or claim adjustments.
• Familiarity with Claim Check, Correct Coding Initiative (CCI), FACETS, CAPS/UWIN, LRSP, or TOPPS.
• Experience working with commercial and government healthcare claims, including Medicare and Medicaid.

Work Arrangement

• 100% remote for candidates residing within the eligible service area in or near Rochester, New York.
• Six-month W-2 contract with the possibility of extension or permanent hire.
• Monday-Friday schedule with flexible start times between 6:00 AM and 10:00 AM.
• Structured training of approximately 4-6 weeks, depending on individual progress.