Certified Medical Coder

Job Title: Claims Payment Policy Lead (Clinical + Coding)

Location: Remote (Must reside in PA, NJ, or DE)

About the Role

We are seeking a Claims Payment Policy Lead to support a dynamic Medical/Claims Policy team. This role sits at the intersection of clinical expertise and healthcare coding/billing, focusing on policy development (not audits) to drive cost efficiency and align with industry standards.

Key Responsibilities

• Lead policy-driven initiatives to identify and implement medical cost-saving opportunities
• Develop and maintain claim payment and medical policies aligned with: CMS/Medicare guidelines, Industry reimbursement practices, State & federal regulations
• Monitor industry trends and regulatory changes
• Analyze utilization patterns and claims data to recommend improvements
• Develop business cases and policy documentation.
• Serve as a clinical and/or coding SME and mentor team members
• Ensure accurate coding alignment (CPT, HCPCS, ICD guidelines)

Required Qualifications

• Must reside in PA, NJ, or DE
• Clinical background (3+ years): RN preferred (open to LPN or other licensed healthcare professionals – PT, allied health, etc.)
• 3–5 years of Medical Coding experience
• Active certification required- CPC, CCS, RHIA, or RHIT
• Strong provider or facility billing experience