Medical Coding & Audit Specialist - Claims Integrity Remote

shifttechnology; United States; Hybrid; USD 65,000 - 95,000; Full time

Benefits offered by this job

Flexible remote and hybrid working

Competitive salary and incentive pay

Learning and development opportunities

Generous PTO and holidays

Mental health benefits

Volunteer days

Global benefits by country

Job summary

Shift Technology is hiring for a role in US Healthcare Payment Integrity and Customer Success to help implement and support solutions that improve claim payment accuracy. You will validate edit logic, assist with audits, and identify opportunities to reduce waste and recover overpayments for customers.

The role requires 3+ years in healthcare claims, 2+ years as a certified medical coder, and in-depth knowledge of Medicare, Medicaid, and Commercial payer regulations.

Qualifications

• 3+ years of experience in healthcare claims, provider billing, or health plan payment integrity.
• 2+ years as a certified medical coder in a payer, provider, or RCM environment.
• Solid Foundation: Working knowledge of Medicare, Medicaid, and Commercial payer regulations.
• Attention to Detail: Proficiency in auditing for coding accuracy (ICD, CPT, HCPCS, modifiers).
• Analytical Mindset: Ability to review data and identify trends or inconsistencies that impact claim accuracy.
• Communication Skills: Strong written and verbal skills; ability to explain technical coding findings clearly to team members.
• Adaptability: Ready to learn and grow in a fast-paced environment while managing multiple tasks effectively.

Responsibilities

• Support Claim Accuracy: Assist in managing pre-pay and post-pay workflows, including claim editing and recovery processes.
• Operationalize Logic: Help define and validate claim edit logic and payment integrity rules to ensure they are functioning correctly for customers.
• Conduct Focused Audits: Perform medical coding audits (inpatient, outpatient, professional) by validating ICD, CPT, HCPCS, and DRG codes under the guidance of senior staff.
• Assist with Reviews: Support the customer appeals process by reviewing billed services and assessing their alignment with policies and coding guidelines.
• Policy Research: Monitor payer policies and industry benchmarks to identify potential gaps in the current edit library and suggest improvements.
• Cross-Functional Collaboration: Partner with Product and Engineering teams to assist in testing, troubleshooting, and User Acceptance Testing (UAT) for new and updated rules.
• Documentation: Maintain clear documentation of audit findings and project progress for internal and external stakeholders.

Skills

Healthcare claims experience

Medical coding (CPC/CCS/CCA)

Auditing for coding accuracy

Communication skills

Analytical mindset

Education

Bachelor's degree in Healthcare Administration or related field

Job description

Shift Technology is hiring for a role in US Healthcare Payment Integrity and Customer Success to help implement and support solutions that improve claim payment accuracy. You will validate edit logic, assist with audits, and identify opportunities to reduce waste and recover overpayments for customers.

The role requires 3+ years in healthcare claims, 2+ years as a certified medical coder, and in-depth knowledge of Medicare, Medicaid, and Commercial payer regulations.