Medical Coding Specialist

Location: Hybrid (Local to Charlotte, NC; Denver, CO; or New York, NY area)

Position Overview

We are seeking a highly motivated Medical Coding Specialist to support the accurate configuration, testing, and maintenance of medical claims processing rules within our platform, Judi®. This role requires deep knowledge of medical coding, health plan operations, and claims adjudication, as well as the ability to translate client requirements into scalable system configurations. The ideal candidate is detail-oriented, adaptable, and passionate about leveraging technology to improve healthcare administration.

Key Responsibilities

• Stay current on coding and coverage guidelines from organizations such as CMS, AMA, AAPC, USPSTF, and other regulatory bodies.
• Utilize CPT, HCPCS, ICD-10, revenue, bill type, place of service, taxonomy, specialty, and related code sets to configure claims processing logic for commercial health plans.
• Configure, test, and maintain coding rules using internal coding and testing tools.
• Translate client requirements into accurate and timely system configurations.
• Research and resolve coding-related questions and escalations from claims processors, Customer Care, Account Management, and other stakeholders.
• Conduct regular claims reviews and audits to ensure coding accuracy, consistency, and compliance.
• Partner closely with Implementation, Benefit Operations, Product, and Technology teams to support new client implementations and platform enhancements.
• Contribute to continuous improvement initiatives that enhance claims processing accuracy and operational efficiency.
• Creates and maintains documentation, job aids, and reporting to support operational effectiveness and compliance.
• Support regulatory audits, quality improvement initiatives, and RFI/RFP responses as needed.
• Develop and maintain departmental resources, including SharePoint sites and other team documentation.
• Performs other duties and responsibilities as needed.

 Required Qualifications

• Bachelor’s degree strongly preferred.
• AAPC Medical Coding & Billing Certification (e.g., CPC) required.
• 5+ years of experience with a health plan, payer, or third-party administrator (TPA).
• Strong understanding of CPT, ICD-10, HCPCS, Revenue Codes, Bill Type Codes, Place of Service Codes, and Taxonomy Codes.
• Medicare and Medicaid experience preferred.
• Demonstrated ability to learn and apply new technologies.
• Proven track record of meeting deadlines and delivering high-quality results.
• Excellent project management, time management, prioritization, and organizational skills.
• Ability to manage multiple priorities in a fast-paced environment.
• Proficiency with Microsoft Office Suite.
• Strong verbal, written, presentation, and interpersonal communication skills.
• Ability to collaborate effectively with cross-functional and virtual teams.

Preferred Qualifications

• Analytical mindset with strong problem-solving skills and attention to detail.
• Customer-focused approach with a passion for improving healthcare operations and driving process improvements.
• Self-starter who can work independently, lead through subject matter expertise, and effectively collaborate across cross-functional teams.
• Experience supporting regulatory audits, developing operational processes, and training or onboarding team members.

This role offers the opportunity to play a key part in ensuring accurate claims processing, supporting client implementations, and helping drive innovation within a growing healthcare technology organization.