Claim Review Specialist

About the role

The Claim Review Specialist supports the Director of Health Information Management in auditing and optimizing client claims. Working remotely, you will use proprietary software to ensure accurate coding, billing, and revenue‑cycle processes for hospital outpatient and professional fee (Profee) claims.

Key responsibilities

• Prepare claim audits and recommend coding, charge, and billing adjustments.
• Develop standardized reports using the company’s software platform.
• Meet with clients to discuss audit findings and answer coding questions.
• Provide written FAQ responses and client education materials.
• Support other members of the revenue‑cycle consulting team.
• Perform additional duties as assigned.

Required profile

• 5+ years of direct experience in revenue cycle and outpatient coding.
• CCS, COC, or CPC certification (required).
• Strong knowledge of medical terminology, anatomy, and clinical documentation.
• Familiarity with CMS and Medicaid guidelines; willingness to learn inpatient coding.
• Proficiency with Microsoft Excel, PowerPoint, Word, and OneNote.
• Analytical thinker with independent decision‑making ability.

Required skills

• Revenue cycle management
• Outpatient coding (ER, SDS, OBS, ancillary, IR, Profee, E/M facility, I&I)
• CCS, COC, CPC certification
• Medical terminology and anatomy
• Clinical documentation
• Inpatient coding (learn on the job)
• CMS Manual and Medicaid guidelines
• Microsoft Excel, PowerPoint, Word, OneNote
• Official Coding Guidelines, HCPCS, MUE, CCI edits, Units of Service, ICD‑10‑CM