Medical Coding – Vendor and Claims Edit Specialist, Health Plan; Pennsylvania resident

Employer Industry: Healthcare Services

• Opportunity for career advancement and growth within the organization
• Work remotely from anywhere in Pennsylvania
• Comprehensive healthcare benefits, including vision and dental, available from day one
• Supportive and collaborative work environment that values diversity
• Chance to make a positive impact on healthcare coding and claims processes

• Act as a leader and resource collaborating with management, physicians, and staff on coding standards
• Apply knowledge of CPT, ICD-10, and HCPCS coding to develop and maintain claim edits
• Research and clarify coding issues, ensuring compliance with clinical and reimbursement policies
• Lead internal development and testing of claims edits and coordinate with vendor partners
• Mentor less experienced staff and compile performance reports for vendor initiatives

• Minimum one certification required:
  Certified Professional Coder (CPC) or Certified Professional Biller through AAPC
• High School Diploma or Equivalent (GED) required
• Minimum of 5 years of related work experience required
• Must possess certification(s) from the American Academy of Professional Coders (AAPC)
• Strong knowledge of coding standards and compliance regulations

• Graduate from a Specialty Training Program
• Minimum of 5 years of experience in Health Insurance/Managed Care