Registered Nurse Coder - 256935

Medix™; New York (NY); Hybrid; USD 90,000 - 120,000; Full time

Job summary

Medix is seeking an RN-Coder Clinical Validation Reviewer in New York, NY (Flatiron District). You will review medical records against billed claims and document clear clinical rationales to support payment integrity.

Collaborate with product and operations teams to test AI-assisted review workflows and refine review processes in a fast-growing healthtech environment.

Qualifications

• CPC and/or CCS certification required.
• Experience reviewing medical records in payer, provider, audit, or claims review.
• Deep knowledge of medical terminology and claim coding.
• Ability to write defensible review rationales.
• Hybrid schedule: 2-3 days in office in Flatiron District, NYC.

Responsibilities

• Review claims against medical records to validate billed services and codes.
• Write clear clinical and coding rationales for audit workflows.
• Identify unsupported claims and potential overpayments.
• Collaborate with product and operations to test AI-assisted tools.

Skills

CPC

CCS

Medical coding

Job description

Our client is a fast-growing healthtech company building AI agents for health plans to streamline care navigation and optimize healthcare spending. On their behalf, we are seeking an RN-Coder Clinical Validation Reviewer to join their team in New York, NY (Flatiron District).

In this role, you will review medical records against billed claims, document clear clinical rationales, and partner directly with product teams to refine AI-supported review workflows.

Key Responsibilities

• Review professional and facility claims against medical records to validate billed services, diagnoses, codes, and payment findings.
• Write clear, professional clinical and coding rationales for payment integrity and audit workflows.
• Identify unsupported claims and potential overpayments.
• Collaborate with product and operations teams to test and give feedback on AI-assisted review tools.

What We’re Looking For

• CPC or CCS certification required (additional coding credentials a plus).
• Experience reviewing medical records in a payer, provider, audit, or claims review setting.
• Deep knowledge of medical terminology, clinical documentation, and claim coding.
• Ability to write high-quality, defensible review rationales.
• Hybrid schedule: 2-3 days/week in office (Flatiron District, NYC).

Nice-to-Haves

• Experience in payment integrity, DRG validation, CDI, or claims auditing.
• Familiarity with CPT, HCPCS, ICD-10, DRG logic, and CMS/AMA guidelines.
• Experience with Medicare Advantage, Medicaid, or commercial health plans.
• Additional credentials (CIC, CPMA, COC, RHIT, RHIA, CCDS, CDIP).

Schedule & Hours

• Full-time (40 hours/week) | Monday-Friday between 8 AM - 6 PM