Medical Coding Specialist

Claritev; United States; On-site; USD 36,000 - 55,000; Full time

Benefits offered by this job

Health insurance

401(k) plan

Bonus opportunity

Job summary

Claritev is seeking a Medical Coding Specialist to analyze billing and apply coding standards for global operations. You will review inpatient and outpatient claims, ensure compliance with HIPAA and international regulations, and support cross-border audits.

Ideal candidates hold a coding certification and have experience with international billing standards, CPT/HCPCS, ICD-9/10, and DRGs, with focus on accuracy and regulatory alignment.

Qualifications

• Bachelor’s degree in healthcare related field and at least 2 years of coding experience.
• Current nursing certification and/or current certified coder (CCS, CCS-P or CPC), RHIA/RHIT.
• Minimum 2 years experience in direct patient care, medical procedure billing, auditing, line item review, coding, and/or reimbursement.
• Knowledge of inpatient/outpatient hospital billing requirements including UB-04s, CPT, HCPCS, ICD-9/10, DRG, APCs, and international equivalents.

Responsibilities

• Review and analyze inpatient, outpatient, and provider billing for medical appropriateness of treatment; analyze charges across revenue centers with international considerations.
• Apply national and international coding standards (ICD-10-AM, OPCS-4, SNOMED CT) to claims billed.
• Prepare clear findings and documentation for cross-border audits or international compliance reviews.
• Research and provide internal responses based on itemized bills, claims, and operative notes, including from international providers.
• Assist with creating or enhancing internal claim and review recommendations.
• Communicate with teammates and management regarding clinical and reimbursement findings.
• Assist with clinical education of staff related to claims and regulatory changes affecting the department.
• Monitor, research, and summarize coding practices and regulatory changes across multiple countries or regions.
• Research and review individual claims, trends, or detailed itemized bills, and other documentation as needed.
• Collaborate across disciplines and departments to ensure accurate coding and billing.

Skills

ICD-10-CM/PCS

HIPAA Compliance

Revenue Codes

Coding Audits

Cross-border Coding

Education

Bachelor’s Degree in Healthcare or related field

Coding Certification (CCS/CPC)

Tools

MS Office Suite

Database software

Job description

Job Description

The Medical Coding Specialist is responsible for providing billing analysis of claims and applying coding standards and federal regulations to ensure correct billing practices. In this role, you will perform bill and chart reviews to identify any variation from quality billing practices and monitor patient bills for accuracy and compliance. This position also requires awareness of international coding systems and healthcare billing practices to support global operations and ensure alignment with international regulatory standards.

Job Roles And Responsibilities

• Review and analyze inpatient, outpatient, and provider billing for medical appropriateness of treatment; analyze charges across various revenue centers with consideration to patient diagnosis, procedures, age, facility type, and international healthcare norms where applicable.
• Apply recommendation of national coding and international coding and regulation standards (e.g., ICD-10-AM, OPCS-4, SNOMED CT) to claims billed.
• Prepare c lear, concise and legible findings, including documentation that may be used in cross-border audits or international compliance reviews.
• Research , review and provide internal response based on receipt of itemized bills, claims, operative notes and other documentation, including those from international providers or translated medical records.
• Assist with, create or enhance internal claim and review recommendations.
• Communicate with co-workers and management regarding clinical and reimbursement findings.
• Assist with clinical education of staff as it relates to clinical aspects of claims, suggesting additional negotiation talking points or tools, and communicating overall industry or regulatory changes which affect the department .
• Monitor, research, and summarize trends, coding practices, and regulatory changes across multiple countries or regions.
• Research and review individual claims, claim trends or detailed itemized bills, operative notes and
• other documentation as needed.
• Collaborate, coordinate, and communicate across disciplines and departments.
• Ensure compliance with HIPAA and international data protection regulations (e.g., GDPR, PIPEDA).
• Demonstrate commitment to the Company’s core values.
• Please note due to the exposure of PHI sensitive data – this role is considered to be a High Risk Role.
• The position responsibilities outlined above are in no way to be construed as all encompassing.
• Other duties, responsibilities, and qualifications may be required and/or assigned as necessary.

Job Scope

This position works independently with general supervision in order to complete the outlined responsibilities. The incumbent balances several projects at a time and work is varied and complex. Complex issues are referred up to higher levels. The incumbent will use established procedures and uses knowledge of the Company’s general business principles, industry dynamics, market trends, and specific operational details when performing all aspects of the job.

JOB REQUIREMENTS (Education, Experience, And Training)

• Minimum completion of educational curriculum required of medical license or coding certification held with Bachelor’s Degree preferred; or minimum Bachelor’s Degree in healthcare related field and at least 2 years of coding experience.
• Current nursing certification and/or current certified coder (CCS, CCS-P or CPC), Registered Health Information Technician (RHIA/RHIT).
• Minimum 2 years experience in direct patient care, medical procedure billing, medical insurance auditing, line item review, audits, coding, and/or reimbursement.
• Knowledge of inpatient/outpatient hospital billing requirements including UB-04s, revenue codes, CPT, HCPCS, ICD-9/10, DRG, APCs, and familiarity with international equivalents (e.g., KSA, ICD-10-AM, ACHI, CCI).
• Knowledge of professional claim billing requirements including HCFA 1500s, CPT codes and ICD-9/ICD-10 diagnoses codes , as well as international claim forms.
• Knowledge of payer reimbursement policies, state and federal regulations, international healthcare systems, and global medical necessity criteria.
• Familiarity with international medical data resources and coding tools.
• Auditing and health information management experience in a healthcare setting preferred.
• Excellent c ommunication (verbal and written), teamwork, training, presentation, negotiation and organizational skills, including cross-cultural communication.
• Proficiency in MS Office Suite and database software; experience with international billing platforms is a plus .
• Ability to handle multiple tasks in a fast paced environment.
• Ability to read and abstract medical records .
• Knowledge of medical terminology, anatomy, and physiology.
• Ability to interact and discuss audit results with providers.
• Required licensures, professional certifications , and/or Board certifications as applicable.
• Individual in this position must be able to work in a standard office environment which requires sitting and viewing monitor(s) for extended periods of time, operating standard office equipment such as, but not limited to, a keyboard, copier and telephone

Compensation

The salary range for this position is $26.09-$40.16 per hour. Specific offers take into account a candidate’s education, experience and skills, as well as the candidate’s work location and internal equity. This position is also eligible for health insurance, 401k and bonus opportunity.

About Us

Why Claritev ?

Healthcare is complex. We help make it clearer.

At Claritev , you'll do work that matters. Together, we're helping make healthcare more transparent and affordable for all through the power of data, technology, and expertise . We offer meaningful opportunities to grow your career, collaborate with talented colleagues, and make an impact on the clients and communities we serve. If you're looking for purpose, growth, and a team that succeeds together, you'll find it here.

What Guides Us

At Claritev , innovation, agility, and a focus on results drive our success. We embrace bold thinking, work as one team, take ownership, and strive for excellence in everything we do - creating meaningful impact for our clients, communities, and each other.

About The Team

My Total Value

Claritev’s Global t Otal r Ewards Philosophy — My Total Value — Is Grounded In Investing In Our Associates And Rewarding Per Formance. This Includes

• Competitive compensation and incentive opportunities (where eligible)
• Medical, d ental, and v ision coverage
• Life and d isability coverage
• 401(k) with c ompany m atch
• Employee s tock p urchase p lan
• Flexible s pending a ccounts and h ealth s avings a ccounts
• Paid t ime o ff and c ompany h olidays
• Paid p arental l eave
• Mental h ealth r e sources
• Tuitio n r eimbursement
• Financial p lanning r esources
• Professional development opportunities

Our Commitment to Inclusion

At Claritev , we believe diverse perspectives strengthen our teams and lead to better outcomes. We are committed to fostering an inclusive workplace where every associate feels respected, valued, and empowered to succeed.

Claritev is an Equal Opportunity Employer and complies with all applicable laws and regulations. Qualified applicants will receive consideration for employment without regard to age, race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other characteristic protected by law.