Medical Coding Specialist

Join Claritev as a Senior Medical Coding Specialist

Claritev is seeking an experienced Senior Medical Coding Specialist to review, analyze, and code the most complex inpatient, outpatient, and practitioner claims. In this role, you’ll ensure accurate billing, compliance with federal regulations, and support professional development for the coding team. You’ll also serve as a subject matter expert, provide mentorship, and help optimize coding operations to drive efficiency, quality, and revenue integrity. This role is ideal for coders with extensive clinical and coding expertise who thrive in a fast-paced healthcare environment.

Key Responsibilities for a Senior Medical Coding Specialist

Coding & Clinical Analysis

• Review and analyze high-dollar, complex inpatient and outpatient claims for medical appropriateness.

• Assign accurate ICD-10, CPT, and HCPCS codes while ensuring compliance with national coding guidelines.

• Abstract clinical data, including diagnoses, procedures, revenue codes, discharge disposition, and physician information.

• Research and resolve billing variations, trends, and discrepancies to ensure payment integrity.

Education, Mentorship & Operations

• Train, mentor, and guide coders, negotiators, and physicians on coding best practices.

• Facilitate daily coding meetings to review complex cases, provide feedback, and create new coding protocols.

• Collaborate with analytics and physician teams to improve coding accuracy and develop coding tools or reference materials.

• Monitor turnaround times, process efficiency, and adherence to coding standards.

Compliance & Quality Assurance

• Ensure compliance with HIPAA regulations, federal and state coding rules, and payer reimbursement policies.

• Maintain expertise in medical coding standards, payer guidelines, DRG/APC assignments, and medical necessity criteria.

• Apply clinical judgment and coding expertise to the most challenging cases, conducting additional research as needed.

• Communicate coding and reimbursement findings clearly to team members and management.

Qualifications & Experience

• Bachelor’s Degree preferred; completion of medical license or coding certification curriculum required.

• Active CCS, CCS-P, CPC, RHIA, or RHIT certification required and maintained.

• Minimum 5 years of experience in direct patient care, medical procedure billing, auditing, coding, or reimbursement.

• Strong knowledge of UB-04s, CPT, HCPCS, ICD-10, DRG, and APC coding.

• Familiarity with payer reimbursement policies, state/federal regulations, and medical necessity standards.

• Experience with professional and facility contract interpretation preferred.

• Proficiency in MS Office (Excel, Outlook, PowerPoint) and coding/abstracting software.

• Strong communication, analytical, and mentoring skills.

• Ability to work evenings or weekends as needed to meet deadlines.

Work Environment & Physical Requirements

• Standard office environment with prolonged sitting and computer use.

• Operate standard office equipment such as keyboards, copiers, and phones.

• Ability to handle multiple tasks in a fast-paced, high-volume environment.

Compensation & Benefits

• Salary range: $75,000 – $90,000, based on experience, skills, and location.

• Eligible for health insurance, 401(k) with company match, and performance bonuses.

• Generous paid time off and 10 company holidays.

• Tuition reimbursement, Employee Assistance Program, life & disability insurance.

• Flexible schedules and professional development opportunities.