Remote Medical Coding Specialist: Claims Integrity & Audits

Shift Technology; Boston (MA); Hybrid; USD 65,000 - 95,000; Full time

Benefits offered by this job

Flexible remote and hybrid options

Learning and development opportunities

Generous PTO and paid holidays

2 MAD Days per year

Job summary

Shift Technology in Boston is seeking a healthcare claims auditor and analyst to join our US Healthcare Payment Integrity and Customer Success team. You will validate edit logic, assist with audits, and help identify opportunities to reduce waste and recover overpayments for customers.

You will work closely with senior specialists, product, and engineering to test new rules, document findings, and support post-pay processes while maintaining high accuracy and compliance with payer regulations.

Qualifications

• Bachelor’s degree in Healthcare Administration, Business, or related field.
• Active medical coding credentials required (CPC, CCS, or CCA).
• 3+ years of experience in healthcare claims or payment integrity.
• Attention to detail in auditing ICD, CPT, HCPCS codes.
• Strong communication skills to explain findings clearly.

Responsibilities

• Assist in managing pre-pay and post-pay workflows, including claim editing and recovery processes.
• Help define and validate claim edit logic and payment integrity rules.
• Perform medical coding audits (inpatient, outpatient, professional).
• Support the customer appeals process by reviewing billed services.
• Monitor payer policies and industry benchmarks to identify gaps in the edit library.
• Collaborate with Product and Engineering to test and validate new rules.
• Maintain clear documentation of audit findings and project progress.

Skills

Healthcare claims

Provider billing

Payment integrity

Attention to detail

Auditing

Communication skills

Education

Bachelor's in healthcare admin

Medical coding credentials CPC/CCS/CCA

Job description

Shift Technology in Boston is seeking a healthcare claims auditor and analyst to join our US Healthcare Payment Integrity and Customer Success team. You will validate edit logic, assist with audits, and help identify opportunities to reduce waste and recover overpayments for customers.

You will work closely with senior specialists, product, and engineering to test new rules, document findings, and support post-pay processes while maintaining high accuracy and compliance with payer regulations.