Medical Coding & Claims Rules Configurator

Transformcap; United States; Hybrid; USD 70,000 - 85,000; Full time

Job summary

Judi Health in the United States is seeking a Medical Coding Specialist to configure, test, and maintain medical claims processing rules within our platform, Judi®. This role requires deep knowledge of medical coding, health plan operations, and claims adjudication, as well as the ability to translate client requirements into scalable system configurations.

The ideal candidate is detail-oriented, adaptable, and passionate about leveraging technology to improve healthcare administration.

Qualifications

• Bachelor’s degree strongly preferred.
• AAPC CPC certification required.
• 5+ years of experience with a health plan, payer, or TPA.
• Strong CPT/ICD-10/HCPCS knowledge.

Responsibilities

• Stay current on coding guidelines from CMS, AMA, AAPC, USPSTF, and other regulatory bodies.
• Configure, test, and maintain coding rules for claims processing.
• Translate client requirements into accurate and timely system configurations.
• Research and resolve coding-related questions from stakeholders.
• Conduct regular claims reviews for coding accuracy, consistency, and compliance.
• Support regulatory audits, quality improvements, and RFI/RFP responses as needed.
• Partner with Implementation, Benefit Operations, Product, and Technology teams to support new client implementations.
• Create and maintain documentation and reporting to support operations.

Skills

CPC certification (AAPC)

CPT/HCPCS/ICD-10

Revenue/Place of Service codes

Project management

MS Office

Cross-functional collaboration

Education

Bachelor’s degree (preferred)

Tools

Microsoft Office Suite

SharePoint

Job description

Judi Health in the United States is seeking a Medical Coding Specialist to configure, test, and maintain medical claims processing rules within our platform, Judi®. This role requires deep knowledge of medical coding, health plan operations, and claims adjudication, as well as the ability to translate client requirements into scalable system configurations.

The ideal candidate is detail-oriented, adaptable, and passionate about leveraging technology to improve healthcare administration.