Specialist, Clinical Services

What You'll Do

In this role, you will have the opportunity to:

• Analyze inpatient, outpatient, and professional claims to ensure billing accuracy, coding integrity, and regulatory compliance.
• Identify billing variances and reimbursement opportunities that improve claim outcomes and support organizational objectives.
• Apply national and international coding standards to enhance the quality and consistency of claim reviews.
• Research complex medical records, itemized bills, operative reports, and supporting documentation to develop evidence-based recommendations.
• Communicate coding, clinical, and reimbursement findings to internal stakeholders and leadership to support informed decision-making.
• Monitor emerging coding practices, healthcare trends, and regulatory changes across domestic and international markets.
• Educate and support colleagues by sharing industry knowledge, claim review insights, and best practices.
• Collaborate across teams and functions to strengthen audit processes, improve compliance, and drive operational excellence.

What You Will Bring

Required Qualifications

• Bachelor's degree in a healthcare-related field; or completion of the educational requirements associated with a current medical license or coding certification.
• Minimum two (2) years of experience in medical coding, billing, claims auditing, reimbursement analysis, line-item bill review, or direct patient care.
• Knowledge of inpatient and outpatient hospital billing requirements, including UB-04 forms, revenue codes, CPT, HCPCS, ICD-9/ICD-10, DRGs, and APCs.
• Knowledge of professional billing requirements, including HCFA-1500 claim forms and related coding methodologies.
• Understanding of payer reimbursement policies, healthcare regulations, and medical necessity guidelines.
• Ability to review, interpret, and abstract medical records.
• Strong communication, organizational, analytical, and collaboration skills.
• Proficiency in Microsoft Office applications and database systems.
• One of the following credentials, as applicable:
  • CCS (Certified Coding Specialist)
  • CCS-P (Certified Coding Specialist - Physician-Based)
  • CPC (Certified Professional Coder)
  • RHIA (Registered Health Information Administrator)
  • RHIT (Registered Health Information Technician)
  • Current nursing licensure/certification

Preferred Qualifications

• Bachelor's degree in a healthcare-related discipline.
• Experience in health information management, medical auditing, or healthcare reimbursement environments.
• Knowledge of international healthcare systems, coding methodologies, and regulatory requirements.
• Familiarity with international coding systems and tools, including ICD-10-AM, ACHI, CCI, OPCS-4, and SNOMED CT.
• Experience reviewing international claims, medical records, or billing platforms.
• Demonstrated ability to present findings and collaborate with providers and cross-functional teams.
• Strong cross-cultural communication skills and experience supporting global healthcare operations.

Compensation

The salary range for this position is $54,267-$83,533 annually.

Actual compensation is based on experience, skills, education, work location, and internal equity. This position may also be eligible for incentive compensation and the comprehensive benefits outlined in the My Total Value section.

Work Location: This is a fully remote role, allowing associates to work from their home office while maintaining compliance with all security, privacy, and performance expectations.

Please note: Due to exposure to Protected Health Information (PHI), this position is designated as a High Risk Role.

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