[Hiring] Senior Medical Coding Specialist @Claritev

Role Description

The Senior Medical Coding Specialist is responsible for analyzing high-dollar, complex claims by applying advanced coding knowledge, research, and regulatory standards to ensure accurate billing practices. This role plays a critical part in identifying billing discrepancies, ensuring compliance, and supporting both domestic and global coding operations. This position requires strong expertise in Workers’ Compensation claims, as well as the ability to apply both U.S. and international coding standards in a fast-paced, high-impact environment.

Key Responsibilities

• Review and analyze complex inpatient, outpatient, and practitioner claims for medical appropriateness and billing accuracy.
• Evaluate charges across revenue centers, considering diagnosis, procedures, patient demographics, and facility type.
• Apply national and international coding standards to ensure compliance and accuracy.
• Support daily operations and departmental processes in partnership with leadership.
• Facilitate claim review discussions, including complex case reviews and feedback sessions.
• Design and deliver coding education, training, and mentorship for new and existing team members.
• Serve as a subject matter expert (SME) for clinical and coding-related questions.
• Monitor turnaround times and recommend process improvements to increase efficiency.
• Research claims, trends, itemized bills, operative notes, and supporting documentation.
• Collaborate with physician and analytics teams to enhance coding edits, guidelines, and best practices.
• Communicate coding, clinical, and reimbursement findings clearly to internal stakeholders.
• Assist in evaluating team performance and supporting staff development initiatives.
• Contribute to department goals, process improvements, and strategic initiatives.
• Ensure compliance with HIPAA and applicable international data protection regulations.

Compensation

The salary range for this position is $70-90k annually. Specific offers take into account a candidate’s education, experience and skills, as well as the candidate’s work location and internal equity. This position is also eligible for health insurance, 401k and bonus opportunity.

Job Scope

This role operates independently with minimal supervision, managing complex and varied workloads. The Senior Medical Coding Specialist applies deep industry knowledge and sound judgment to resolve issues, while escalating highly complex cases as needed. Success in this role requires strong analytical skills, attention to detail, and the ability to balance multiple priorities in a deadline-driven environment.

Qualifications

• Minimum of 2+ years of Workers’ Compensation coding experience required.
• Current coding certification (AHIMA or AAPC) or active medical license (RN, MD) required.
• 7+ years of experience in a clinically related field (e.g., coding, auditing, nursing, radiology, laboratory, pharmacy, physician assistant roles).
• Extensive knowledge of inpatient and outpatient billing, including UB-04, revenue codes, CPT, HCPCS, ICD-10, DRG, and APCs.
• Familiarity with international coding systems (e.g., ICD-10-AM, OPCS-4, SNOMED CT, CCI) preferred.
• Strong understanding of payer reimbursement policies, medical necessity criteria, and regulatory standards.
• Experience with auditing and health information management preferred.
• Proficiency in Microsoft Office, including Excel, Outlook, and PowerPoint; Visio a plus.
• Strong analytical, problem-solving, and decision-making skills.
• Excellent communication skills, including the ability to explain complex coding concepts clearly.
• Ability to develop training materials and support knowledge sharing across teams.
• Ability to manage multiple priorities in a fast-paced environment.
• Strong attention to detail and ability to work independently.
• Ability to work flexible hours, including evenings or weekends as needed.

Benefits

• Medical, dental and vision coverage with low deductible & copay.
• Life insurance.
• Short and long-term disability.
• Paid Parental Leave.
• 401(k) + match.
• Employee Stock Purchase Plan.
• Generous Paid Time Off – accrued based on years of service.
• 10 paid company holidays.
• Tuition reimbursement.
• Flexible Spending Account.
• Employee Assistance Program.
• Sick time benefits – for eligible employees, one hour of sick time for every 30 hours worked, up to a maximum accrual of 40 hours per calendar year.