Remote Claims Edit & Vendor Integrity Specialist

Geisinger; Pennsylvania; Hybrid; USD 70,000 - 90,000; Full time

Benefits offered by this job

Healthcare benefits from day one (incl

Vision & dental coverage

Job summary

Geisinger is seeking a skilled coder with extensive experience in healthcare claims and payment integrity to lead and optimize vendor-edited claim processes. The role focuses on CPT, ICD-10, and HCPCS coding, ensuring payment accuracy and policy compliance across internal and external activities.

You will collaborate with providers, account managers, and cross-functional teams to enhance claim edits, tests, and deployment with new vendors, while mentoring junior staff.

Qualifications

• Minimum of five years of health insurance/managed care experience.
• CPC and/or AHIMA certifications required.
• Experience supporting external vendors in claims/payments environment.

Responsibilities

• Lead collaboration with management, physicians and staff using national coding standards.
• Develop and maintain claim edits with CPT/ICD-10/HCPCS knowledge.
• Determine payment compliance with clinical and reimbursement policies.
• Research CPT codes to clarify coding issues as needed.
• Coordinate vendor partnerships and identify new opportunities.
• Lead the yearly opportunity analysis and vendor reviews.
• Respond to claim edit appeals and rational requests.
• Mentor staff and support internal workgroups/committees.
• Develop and expand internal claims edits and policy management.

Skills

CPT coding

ICD-10 coding

HCPCS coding

Vendor management

Education

Certified Coding Specialist - AHIMA

Certified Professional Coder - AAPC

High School Diploma or GED

Job description

Geisinger is seeking a skilled coder with extensive experience in healthcare claims and payment integrity to lead and optimize vendor-edited claim processes. The role focuses on CPT, ICD-10, and HCPCS coding, ensuring payment accuracy and policy compliance across internal and external activities.

You will collaborate with providers, account managers, and cross-functional teams to enhance claim edits, tests, and deployment with new vendors, while mentoring junior staff.