Remote Claims Integrity & Vendor Partnerships Lead

geisinger; United States; Remote; USD 65,000 - 90,000; Full time

Job summary

Geisinger is seeking an experienced healthcare coder to collaborate with external vendors on claims and payment integrity, including implementation support, edit validation, escalation, and ongoing vendor relationship management.

The role emphasizes CPT/ICD-10/HCPCS coding to maintain and develop prospective claim edits, ensure payment compliance, and lead governance with vendor partners while mentoring junior staff. The position supports ongoing performance reporting and strategic opportunities.

Qualifications

• Must hold CPC (AAPC) or Certified Coding Specialist (AHIMA)
• At least 5 years of related health insurance/ managed care experience
• HS diploma required; specialty training preferred

Responsibilities

• Lead and support the team to ensure coding accuracy and issue resolution with vendors.
• Maintain and develop claim edits with CPT, ICD-10, HCPCS knowledge.
• Evaluate payment compliance with clinical and reimbursement policies.
• Coordinate vendor opportunities and annual analyses.
• Mentor staff and participate in performance reporting.

Skills

Coding accuracy

Vendor collaboration

Leadership

Policy knowledge

Education

CPC (AAPC) certification

Certified Coding Specialist (AHIMA)

High School Diploma or GED

Job description

Geisinger is seeking an experienced healthcare coder to collaborate with external vendors on claims and payment integrity, including implementation support, edit validation, escalation, and ongoing vendor relationship management.

The role emphasizes CPT/ICD-10/HCPCS coding to maintain and develop prospective claim edits, ensure payment compliance, and lead governance with vendor partners while mentoring junior staff. The position supports ongoing performance reporting and strategic opportunities.