Certified Medical Coding Specialist

Shift Technology • Boston, MA

9d • $65,000 - $95,000

About The Position

As part of Shift’s US Healthcare Payment Integrity and Customer Success organization, the Certified Medical Coding Specialist uses technical and clinical coding knowledge to help implement and support solutions that improve claim payment accuracy. Working closely with senior specialists, product teams, and technical teams, the role helps validate edit logic, assists with audits, and identifies opportunities to reduce waste and recover overpayments for customers.

Requirements

• At least 3 years of experience in healthcare claims, provider billing, or health plan payment integrity.
• At least 2 years of experience as a certified medical coder in a payer, provider, or revenue cycle management (RCM) environment.
• Working knowledge of Medicare, Medicaid, and commercial payer regulations.
• Proficiency in auditing coding accuracy, including ICD, CPT, HCPCS, and modifiers.
• Ability to review data and identify trends or inconsistencies that impact claim accuracy.
• Strong written and verbal communication skills, including the ability to explain technical coding findings clearly to team members.
• Ability to learn and grow in a fast-paced environment while managing multiple tasks effectively.
• Bachelor’s degree in Healthcare Administration, Business, or a related field, or equivalent experience.
• Active medical coding credential required: CPC, CCS, or CCA.

Responsibilities

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

Benefits

• Flexible remote and hybrid working options.
• Competitive salary and a variable component tied to personal and company performance.
• Learning and development opportunities, including Focus Fridays, a half-day each month for learning and personal growth.
• Generous paid time off and paid holidays.
• Mental health benefits.
• Two paid MAD (Make A Difference) volunteer days per year.
• Additional benefits may be offered based on country and eligibility.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level