RN Coder

Medix; New York (NY); Hybrid; USD 79,000 - 100,000; Full time

Job summary

Medix is seeking an RN-Coder Clinical Validation Reviewer to support payment integrity and clinical validation workflows in a hybrid setup. The role emphasizes reviewing medical records against claims to determine support for billed services, with documentation of clear clinical and coding rationales.

Ideal candidates are active RNs with CPC or CCS certs, experienced in inpatient/outpatient review and familiar with CPT/ICD coding rules, ready to work 2-3 days in the Flatiron, NY office or

Qualifications

• Active RN with license in good standing.
• CPC or CCS certification required; additional credentials are a plus.
• Experience reviewing medical records in inpatient/outpatient payer environments.
• Strong understanding of medical terminology and coding.
• Ability to determine whether a claim is supported by the medical record.
• Ability to write clear, professional review rationales for payer workflows.

Responsibilities

• Review professional and/or facility claims against medical records to determine if billed services are supported.
• Document clinical and coding rationale for reviews and potential findings.
• Identify potential overpayments or unsupported claims and escalate as needed.
• Collaborate with product and operations teams to improve AI-supported review workflows.

Skills

Active RN license

CPC or CCS certification

Medical records review

Medical terminology knowledge

Claim support determination

Clear review rationales

Attention to detail

Hybrid NYC office availability

Job description

Job Title: RN Coder

Summary:

We're hiring RNs to oversee and work the claims data and review possible/flagged claims for overpayment. The main part of this job is the clinical decision making where they can either make a determination, ask for more documentation, or elevate to MDs for their review. For example, there are at times heart injuries that are upcoded to heart attacks and the payment is very large and overpaid. The nurses need to be able to review the clinical work and understand the coding and then be able to make the determination of next steps.

RM will be getting batches of data with flags and comments of where they need the information and delineation from the clinical staff. They are building out an internal system that will mimic those like Cotiviti, etc. and they nurses will be trained on that program.

The cases will be reviews of both inpatient and outpatient but the work will mainly skew inpatient because of the cost of the work. They will be doing both facility and physician billing as well.

Overview:

We are looking for an RN-Coder Clinical Validation Reviewer to support payment integrity and clinical validation workflows. The ideal candidate is an active RN who also holds a coding credential such as CPC or CCS and has experience reviewing medical records against claims, reimbursement policies, coding rules, or clinical documentation.

You will review professional and/or facility claims against medical records to determine whether the billed service, diagnosis, procedure, code, or payment finding is supported. You will document clear clinical and coding rationale, help identify potential overpayments or unsupported claims, and work closely with Akita's product and operations team to improve AI-supported review workflows.

This role is especially well suited for someone who has worked in payment integrity, clinical documentation review, or coding validation.

Required Skills:

• Active RN license in good standing (state requirements TBC).
• Current CPC or CCS certification required; additional coding credentials are a plus.
• Experience reviewing medical records in an inpatient, outpatient, payer, provider, audit, or claims review environment.
• Strong understanding of medical terminology, clinical documentation, and claim coding.
• Ability to determine whether a claim is supported or unsupported based on the medical record.
• Ability to write clear, professional review rationales that could be used in payer, provider, audit, or recovery workflows.
• Strong attention to detail and ability to maintain consistent review standards.
• Comfort working independently in a hybrid environment, including 2-3 days in office required from our Flatiron office in New York, NY.

Preferred Skills:

• Experience in payment integrity, clinical validation, DRG validation, coding validation, CDI, utilization review, claims audit, or overpayment review. Familiarity with CPT, HCPCS, ICD-10-CM, ICD-10-PCS, DRG logic, modifiers, CMS/AMA coding rules, CMS coverage policies, or payer reimbursement policies.
• Experience with medical claims platforms, coding tools, EHR/medical record systems, or audit/recovery workflows.
• Experience working with Medicare Advantage, Medicaid, commercial health plans, or managed care organizations.
• Experience reviewing provider disputes, appeals, rebuttals, or audit responses.
• Additional credentials such as CIC, CPMA, COC, RHIT, RHIA, CCDS, or CDIP. ? Comfort giving feedback on new software tools, workflows, or AI-generated review outputs.

Schedule/Shift: Monday-Friday, 40 hours a week between 8am-6pm EST

Pay: $79,000-100,000+ (negotiable DOE)

Location: remote or can sit in Flatiron NY office