RN-Coder: Clinical Validation & Payment Integrity (Remote)

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

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