[Hiring] Certified Medical Coding Specialist @Shift Technology

Role Description

As part of our US Healthcare Payment Integrity and Customer Success organization, you will use your technical and clinical coding knowledge to help implement and support solutions that improve claim payment accuracy. Working closely with senior specialists, product, and technical teams, you will help validate edit logic, assist with audits, and identify opportunities to reduce waste and recover overpayments for our customers.

• Support Claim Accuracy: Assist in managing pre-pay and post-pay workflows, including claim editing and recovery processes.
• Operationalize Logic: Help define and validate claim edit logic and payment integrity rules to ensure they are functioning correctly for customers.
• Conduct Focused Audits: Perform medical coding audits (inpatient, outpatient, professional) by validating ICD, CPT, HCPCS, and DRG codes under the guidance of senior staff.
• Assist with Reviews: Support the customer appeals process by reviewing billed services and assessing their alignment with policies and coding guidelines.
• Policy Research: Monitor payer policies and industry benchmarks to identify potential gaps in the current edit library and suggest improvements.
• Cross-Functional Collaboration: Partner with Product and Engineering teams to assist in testing, troubleshooting, and User Acceptance Testing (UAT) for new and updated rules.
• Documentation: Maintain clear documentation of audit findings and project progress for internal and external stakeholders.

Qualifications

• 2+ years of experience in healthcare claims, provider billing, or health plan payment integrity.
• 1+ years as a certified medical coder in a payer, provider, or RCM environment.
• Working knowledge of Medicare, Medicaid, and Commercial payer regulations.
• Proficiency in auditing for coding accuracy (ICD, CPT, HCPCS, modifiers).
• Ability to review data and identify trends or inconsistencies that impact claim accuracy.
• Strong written and verbal skills; ability to explain technical coding findings clearly to team members.
• Ready to learn and grow in a fast-paced environment while managing multiple tasks effectively.

Requirements

• Bachelor’s degree in Healthcare Administration, Business, or a related field (or equivalent experience).
• Active medical coding credentials required (CPC, CCS, or CCA).
• Must be authorized to work in the US without employment sponsorship.

Benefits

• Flexible remote and hybrid working options.
• Competitive Salary and a variable component tied to personal and company performance.
• Multiple Learning and Development opportunities, including Focus Fridays, a half-day each month to focus on learning and personal growth.
• Generous PTO and paid holidays.
• Mental health benefits.
• 2 MAD Days per year (Make A Difference Days for paid volunteering).
• Additional benefits may be offered by country, based on your eligibility.