Senior Medical Coding Specialist- WC Experience
About The Position
At Claritev, we pride ourselves on being a dynamic team of innovative professionals. Our purpose is simple – we strive to bend the cost curve in healthcare for all. Our dedication to service excellence extends to all stakeholders, both internal and external, driving us to consistently exceed expectations. We are intentionally bold, we foster innovation, we nurture accountability, we champion diversity, and empower each other to illuminate our collective potential. Be part of our transformational journey as we continue to evolve into a leading technology, data, and innovation voice in healthcare. Onward and Upward!!! -------------------------------------------------------------------------------- Job Summary 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.
Requirements
- 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
- 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
Nice To Haves
- Familiarity with international coding systems (e.g., ICD-10-AM, OPCS-4, SNOMED CT, CCI) preferred
- Experience with auditing and health information management preferred
- Proficiency in Microsoft Office, including Excel, Outlook, and PowerPoint; Visio a plus
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
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, unless the laws of the state in which the employee is located provide for more generous sick time benefits
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
