Part-time Biller/Coder – Claims Analyst

Alera Group•UNAVAILABLE, UNAVAILABLE

11d•Remote

About The Position

Vital Incite, an Alera Group company, is looking to add an experienced Biller/Coder – Claims Analyst to their team on a part-time basis (approximately 5–8 hours per week with flexible scheduling). Alera Group was founded in 2017 and has grown to become the 14th largest broker of U.S. business. We are passionate about our clients’ success in the areas of Employee Benefits, Property and Casualty Insurance, and Financial Services. With a network of offices nationwide, our commitment to collaboration allows us to offer national resources combined with local service. The Part-time Biller/Coder – Claims & Alert/Trigger Criteria supports Vital Oversight’s continuous monitoring of medical and pharmacy claims by reviewing claims for coding accuracy and reimbursement appropriateness and by developing and maintaining alert and trigger logic that identifies high-risk or outlier claims. This role works collaboratively with claims, clinical, and oversight stakeholders to surface actionable findings that support proactive cost and payment integrity oversight.

Requirements

Active billing/coding credential such as CPC, CCS, CCS-P, RHIA, RHIT, or equivalent
3+ years of experience in medical billing, coding, or claims review

Nice To Haves

Payment integrity, audits, or overpayment recovery
High-cost claims and specialty drug billing
Designing rules, edits, or analytics-driven claim flags

Responsibilities

Review medical and/or pharmacy claims to validate coding accuracy, billed services, and reimbursement appropriateness.
Identify potential coding errors, modifier misuse, payment discrepancies, and outlier reimbursement patterns.
Document clear findings and rationale to support carrier or PBM follow-up and recovery efforts.
Collaborate with claims specialists and clinical stakeholders to ensure findings are actionable.
Develop and maintain trigger logic that identifies high-risk or outlier claims, including cost thresholds by CPT, HCPCS, J-code, or episode of care.
Design triggers for emerging risk patterns such as modifier trends, unusual line splitting, or place-of-service cost anomalies.
Document trigger specifications, including logic, thresholds, rationale, and examples.
Perform quality checks on trigger output to reduce false positives and improve signal quality.
Conducts oneself with a high degree of integrity and professionalism.
Creates and maintains positive working relationships through trust, dependability, and collaboration.
Demonstrates strong attention to detail and accountability for accuracy.
Works independently with strong time management and organization skills.
Communicates clearly and effectively in written documentation.
Demonstrates a continuous improvement mindset aligned with Oversight goals.