Medical Coding Specialist
Judi Health is an enterprise health technology company providing a comprehensive suite of solutions for employers and health plans, including Judi Rx (a public-benefit PBM for self-insured employers), Judi Health™ (full-service health-benefit management), and Judi®, the industry’s leading Enterprise Health Platform that consolidates all claim-administration workflows in one scalable, secure platform. Together with our clients, we’re rebuilding trust in U.S. healthcare.
About the role
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.
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.
- Create and maintain 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.
- Perform other duties and responsibilities as needed.
Requirements
- 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 collaborate across cross-functional teams.
- Experience supporting regulatory audits, developing operational processes, and training or onboarding team members.
Pay
- New York, NY: $70,000 USD – $85,000 USD
- Denver, CO: $70,000 USD – $85,000 USD
- Charlotte, NC: $70,000 USD – $85,000 USD
Location: Hybrid (local to Charlotte, NC; Denver, CO; or New York, NY area).