Claim Review Specialist
New
USA-basedFull-TimeMiddle
Salary not disclosed
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Job Details
- Experience
- 5+ years
- Required Skills
- Microsoft Excel
Requirements
- 5+ years of directly related experience in revenue cycle, outpatient coding, or healthcare auditing
- Certification required (CCS, COC, or CPC)
- Strong knowledge of outpatient coding (ER, SDS, OBS, Profee, E/M facility, ancillary services)
- Solid understanding of CMS guidelines, ICD-10-CM, CPT/HCPCS, and payer-specific billing rules
- Experience with revenue cycle workflows, denial management, and charge capture processes
- Proficiency in Microsoft Excel, Word, PowerPoint, and documentation tools
- Strong analytical thinking, attention to detail, and independent decision-making skills
- Excellent written and verbal communication skills, with the ability to simplify complex coding topics
Responsibilities
- Conduct detailed audits of outpatient and professional fee claims to identify coding, billing, and documentation issues
- Analyze claims using CMS, Medicaid, and payer-specific guidelines to ensure compliance and accuracy
- Use proprietary software tools to select, organize, and review claims based on data trends and audit priorities
- Support the development of standardized reports, client presentations, and educational materials
- Respond to coding-related questions and assist in client communication with clear, professional guidance
- Contribute to documentation improvement and revenue cycle optimization initiatives
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