Certified Medical Coding Specialist

🕒 March 20

🇺🇸 United States – Remote

💵 $65k - $95k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🏥 Medical Billing and Coding

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 47%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Shift Technology

WebsiteLinkedInAll Job Openings

201 - 500 employees

Founded 2014

🤖 Artificial Intelligence

🛡️ Insurance

☁️ SaaS

💰 $220M Series D on 2021-11

Artificial Intelligence • Insurance • SaaS

Shift Technology is a company that specializes in AI-driven solutions for the insurance industry. They offer a variety of products designed to optimize critical insurance decisions, with a focus on fraud detection, risk detection, and claims management. Leveraging deep insurance expertise and advanced artificial intelligence technology, Shift Technology helps major insurance providers across the globe improve decision-making accuracy and efficiency. Their solutions are highly reliable, secure, and capable of providing clear explanations for each decision made, supporting compliance efforts in areas like AML/KYC. Trusted by some of the top insurers worldwide, Shift Technology has established itself as a leader in the field of AI for insurance.

📋 Description

• 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 • Perform medical coding audits for inpatient, outpatient, and professional claims by validating ICD, CPT, HCPCS, and DRG codes under senior staff guidance • Support the customer appeals process by reviewing billed services and assessing alignment with policies and coding guidelines • Monitor payer policies and industry benchmarks to identify gaps in the 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 documentation of audit findings and project progress for internal and external stakeholders

🎯 Requirements

• 3+ years of experience in healthcare claims, provider billing, or health plan payment integrity • 2+ years as a certified medical coder in a payer, provider, or RCM environment • Working knowledge of Medicare, Medicaid, and Commercial payer regulations • Proficiency in auditing for coding accuracy (ICD, CPT, HCPCS, modifiers) • Ability to review data and identify trends or inconsistencies that impact claim accuracy • Strong written and verbal skills; 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 credentials required (CPC, CCS, or CCA)

🏖️ Benefits

• Flexible remote and hybrid working options • Competitive Salary and a variable component tied to personal and company performance • Multiple Learning and Development opportunities, including Focus Fridays, a half-day each month to focus on learning and personal growth • Generous PTO and paid holidays • Mental health benefits • 2 MAD Days per year (Make A Difference Days for paid volunteering) • Additional benefits may be offered by country, based on your eligibility