Remote Medical Coding Specialist: Claims & Payment Integrity

Shift Technology; United States; Hybrid; USD 65,000 - 95,000; Full time

Job summary

Shift Technology is expanding its US Healthcare Payment Integrity and Customer Success team. The role leverages clinical coding knowledge to validate edit logic, perform audits, and assist with reviews to improve claim payment accuracy.

You will collaborate with senior specialists, product, and engineering teams in a fast-paced, patient-focused environment. The position supports flexible remote and hybrid work options in the United States, with a base salary range and a comprehensive rewards

Qualifications

• Bachelor’s degree in Healthcare Administration or related field.
• Active medical coding credentials required (CPC, CCS, or CCA).
• Experience with Medicare, Medicaid, and Commercial payer regulations.

Responsibilities

• Support Claim Accuracy: Manage pre-pay and post-pay workflows, including claim editing and recovery.
• Operationalize Logic: Define and validate claim edit logic and integrity rules.
• Conduct Focused Audits: Perform medical coding audits across ICD, CPT, HCPCS, DRG.
• Assist with Reviews: Support appeals by reviewing billed services against policies.
• Policy Research: Monitor payer policies to identify gaps in edit library.
• Cross-Functional Collaboration: Work with Product and Engineering for testing and UAT.
• Documentation: Document audit findings and project progress.

Skills

Healthcare claims

Medical coding

Payer regulations

Auditing accuracy

Data analysis

Communication skills

Adaptability

Education

Bachelor's degree

CPC/CCS/CCA

Job description

Shift Technology is expanding its US Healthcare Payment Integrity and Customer Success team. The role leverages clinical coding knowledge to validate edit logic, perform audits, and assist with reviews to improve claim payment accuracy.

You will collaborate with senior specialists, product, and engineering teams in a fast-paced, patient-focused environment. The position supports flexible remote and hybrid work options in the United States, with a base salary range and a comprehensive rewards