Medical Coding Specialist

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

About Judi Health

Judi Health is an enterprise health technology company providing a comprehensive suite of solutions for employers and health plans, including:

• Judi Rx, a public benefit corporation delivering full-service pharmacy benefit management (PBM) solutions to self-insured employers,
• Judi Health™, which offers full-service health benefit management solutions to employers, TPAs, and health plans, and
• Judi®, the industry’s leading proprietary Enterprise Health Platform (EHP), which consolidates all claim administration-related workflows in one scalable, secure platform.

Together with our clients, we’re rebuilding trust in healthcare in the U.S. and deploying the infrastructure we need for the care we deserve. To learn more, visit www.judi.health.

Location: Hybrid (Local to Charlotte, NC; Denver, CO; or New York, NY area)

Position Overview

We are seeking a highly motivated Medical Coding Specialist to support the accurate configuration, testing, and maintenance of 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.

Key Responsibilities

• Stay current on coding and coverage guidelines from organizations such as 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 closely with Implementation, Benefit Operations, Product, and Technology teams to support new client implementations and platform enhancements.
• Contribute to continuous improvement initiatives that enhance claims processing accuracy and operational efficiency.
• Creates and maintains documentation, job aids, and reporting to support operational effectiveness and compliance.
• Support regulatory audits, quality improvement initiatives, and RFI/RFP responses as needed.
• Develop and maintain departmental resources, including SharePoint sites and other team documentation.
• Performs other duties and responsibilities as needed.

Required 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.
• Medicare and Medicaid experience preferred.
• Demonstrated ability to learn and apply new technologies.
• Proven track record of meeting deadlines and delivering high-quality results.
• Excellent project management, time management, prioritization, and organizational skills.
• Ability to manage multiple priorities in a fast-paced environment.
• Proficiency with Microsoft Office Suite.
• Strong verbal, written, presentation, and interpersonal communication skills.
• Ability to collaborate effectively with cross-functional and virtual teams.

Preferred Qualifications

• Analytical mindset with strong problem-solving skills and attention to detail.
• Customer-focused approach with a passion for improving healthcare operations and driving process improvements.
• Self-starter who can work independently, lead through subject matter expertise, and effectively collaborate across cross-functional teams.
• Experience supporting regulatory audits, developing operational processes, and training or onboarding team members.

This role offers the opportunity to play a key part in ensuring accurate claims processing, supporting client implementations, and helping drive innovation within a growing healthcare technology organization.

New York, NY Salary Range: $70,000 — $85,000 USD

Denver, CO Salary Range: $70,000 — $85,000 USD

Charlotte, NC Salary Range: $70,000 — $85,000 USD

All employees are responsible for adherence to the Judi Health Code of Conduct including the reporting of non-compliance. This position description is designed to be flexible, allowing management the opportunity to assign or reassign duties and responsibilities as needed to best meet organizational goals.

We provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

By submitting an application, you agree to the retention of your personal data for consideration for a future position at Judi Health. More details about Judi Health's privacy practices can be found at https://www.judi.health/legal/privacy-policy.