C&S Clinical Coding Analyst

About Our Client:The organization operates globally in the healthcare sector, utilizing technology to improve health outcomes by connecting individuals with care, pharmacy benefits, data, and resources. It focuses on advancing health optimization and serving communities at scale. About the Opportunity:The C&S CLINICAL CODING ANALYST role involves ensuring the accuracy of provider claims by reviewing medical records and applying coding and compliance guidelines. This position impacts the organization by supporting accurate payment decisions, identifying billing irregularities, and maintaining compliance in a production-driven environment. Responsibilities:Perform quality audits of clinical review cases involving CPT, HCPCS, and modifiersAssess accuracy of medical coding, billing, and payment recommendations for pre-payment claimsInterpret state and federal mandates, benefit language, and reimbursement policiesDetermine appropriate level of service using Evaluation and Management coding principlesEnsure compliance with state, federal, and contract policiesIdentify aberrant billing patterns, potential fraud, waste, or abuseManage daily case review assignments meeting quality and productivity standardsProvide clinical expertise to investigative and analytical teamsParticipate in team and department meetingsWork collaboratively and independently as neededServe as a clinical resource within the investigative teamCollaborate with business partners to obtain information relevant to clinical reviews Requirements:High School Diploma or GEDAHIMA or AAPC Certified coder (CPC, CCS, CCS-P)Minimum 2 years as certified coder with experience in CPT/HCPCS/ICD/Modifiers – 10/CM/PCS codingAt least 2 years working with health insurance terminology and regulatory guidelinesMinimum 1 year in a team environment with metric-driven daily production and quality standardsIntermediate experience in medical record reviewIntermediate computer skills with problem-solving abilityProficiency in Microsoft and Adobe applications (Outlook, PowerPoint, Word, Excel, PDF) Preferred Qualifications:Bachelor’s degreeHealthcare claims or processing experienceStrong communication and data interpretation skillsExperience with Fraud, Waste & Abuse or Payment IntegrityExperience with subsequent or reconsideration reviews for FWAEAnalytical skills with medical terminology and coding Pay Range and Compensation Package:The hourly pay for this role ranges from $24.00 to $43.00 based on full-time employment, education, experience, certifications, and local labor markets.Benefits include a comprehensive package, incentive programs, equity stock purchase, and 401(k) contributions, subject to eligibility. Benefits & Perks:401(k) Equal Opportunity Statement: Our client is an equal opportunity employer. They celebrate diversity and are committed to creating an inclusive environment for all employees. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, or national origin. Note:RemoteHunter is a recruitment partner of this role. Please note that all employment decisions, including candidate assessment, interviews, hiring, compensation, and employment terms, are made exclusively by the hiring employer.