Claim Review Specialist

This position is posted by Jobgether on behalf of a partner company. We are currently looking for a Claim Review Specialist in United States.

This role sits at the intersection of clinical coding expertise and revenue cycle integrity, supporting healthcare clients through detailed claim review and audit processes. You will analyze hospital outpatient and professional fee claims using specialized tools to identify coding, billing, and documentation discrepancies. Working closely with leadership and consulting teams, you will help translate complex reimbursement rules into clear, actionable insights for clients. The position is fully remote and designed for professionals who thrive in detail-heavy, analytical environments. You will contribute directly to improving financial accuracy and compliance across healthcare organizations. Strong communication skills are essential, as you will also support client education and respond to coding inquiries. This is a high-impact role where precision and expertise directly influence revenue outcomes and client satisfaction.

Accountabilities

In this role, you will support claim audit activities and revenue cycle consulting efforts by reviewing, analyzing, and validating complex healthcare claims. You will leverage proprietary tools and regulatory knowledge to ensure accuracy in coding, billing, and reimbursement alignment. You will also collaborate with internal teams and clients to deliver clear insights and recommendations that improve processes and outcomes.

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

Requirements

The ideal candidate brings deep expertise in medical coding and revenue cycle processes, along with strong analytical and communication skills. You are comfortable working independently in a highly detail-oriented environment and can interpret complex regulatory frameworks with accuracy.

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

Benefits

Fully remote work arrangement (USA-based)
Opportunity to work with advanced healthcare analytics and proprietary audit tools
Professional development in revenue cycle consulting and clinical coding expertise
Exposure to complex, high-impact healthcare audit projects
Collaborative, mission-driven environment focused on client success
Support for maintaining certifications and continuing education
Comprehensive workplace tools and structured consulting processes

How Jobgether works:

We use an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. Our system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company. The final decision and next steps (interviews, assessments) are managed by their internal team.

We appreciate your interest and wish you the best!

Why Apply Through Jobgether?

Data Privacy Notice: By submitting your application, you acknowledge that Jobgether will process your personal data to evaluate your candidacy and share relevant information with the hiring employer. This processing is based on legitimate interest and pre-contractual measures under applicable data protection laws (including GDPR). You may exercise your rights (access, rectification, erasure, objection) at any time.

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Requirements

Benefits

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