Claims Examiner

firstsourc • Remo, VA

6d • Hybrid

About The Position

We are seeking an experienced Certified Professional Coder (CPC) to support medical record reviews and coding validation activities for U.S. healthcare clients. This position will play a critical role in reviewing medical documentation associated with claim disputes and determining whether diagnosis codes submitted by providers are appropriate, sufficiently specific, and compliant with applicable coding guidelines.

Requirements

• One of the following certifications: AAPC: CPC / AHIMA: CCS or CCA
• At least 2 years of professional medical coding experience.
• Call center experience (required).
• Experience with U.S. healthcare reimbursement
• Experience with Medical record review
• Experience with Medicare, Medicaid, commercial insurance, or managed care
• Experience with Clinical documentation review
• Proficiency with ICD-10-CM
• Proficiency with CPT
• Proficiency with HCPCS
• Proficiency with Medical terminology
• Proficiency with Anatomy and physiology
• Proficiency with EHR systems (such as Epic, MEDITECH, eClinicalWorks, 3M Encoder)
• Proficiency with Microsoft Office
• Experience with claim denials, appeals, audits, or coding validation.
• Managed Care or Medicaid coding experience.
• Associate degree in Health Information Management, Medical Coding, Healthcare Administration, or a related field (or equivalent experience).
• Excellent verbal, written, reading, and presentation skills.
• Fully bilingual in English and Spanish (required).
• Intermediate to advanced proficiency in computer applications and Microsoft Office
• Availability to work rotating eight (8)-hour shifts in a Monday through Friday operation between 8:00 a.m. and 11:00 p.m.
• Occasional availability to work weekends and holidays may be required based on operational needs.

Responsibilities

• Review medical records and validate diagnosis and procedure codes.
• Ensure coding complies with ICD-10-CM, CPT, HCPCS, CMS, HIPAA, and payer guidelines.
• Review claim denials, appeals, audits, and coding disputes.
• Identify opportunities for more specific diagnosis coding when documentation supports it.
• Document coding decisions and collaborate with providers and operations staff.
• Maintain coding accuracy, productivity, and confidentiality of PHI.

Benefits

• Opportunities for professional growth and career development.
• Leadership and training programs.
• Paid time off.
• Retirement plan.
• The opportunity to be part of a global organization committed to excellence and innovation.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree