Certified Medical Coding Specialist

About the role

Shift delivers AI agents that transform insurers' most critical work. By combining deep industry expertise and unmatched data resources, Shift provides proven results that have earned the trust of hundreds of the world's leading insurers. Our insurance-grade AI is accurate, explainable, and secure-empowering human experts to move with unmatched speed, total confidence, and a renewed focus on the people they serve.

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Our culture is built on innovation, trust, and a drive to transform the insurance industry through our SaaS platform. We come from more than 50 different countries and cultures and together we are creating the future of insurance.

As part of our US Healthcare Payment Integrity and Customer Success organization, you will use your technical and clinical coding knowledge to help implement and support solutions that improve claim payment accuracy. Working closely with senior specialists, product, and technical teams, you will help validate edit logic, assist with audits, and identify opportunities to reduce waste and recover overpayments for our customers.

What you'll do

• Support Claim Accuracy: Assist in managing pre-pay and post-pay workflows, including claim editing and recovery processes.
• Operationalize Logic: Help define and validate claim edit logic and payment integrity rules to ensure they are functioning correctly for customers.
• Conduct Focused Audits: Perform medical coding audits (inpatient, outpatient, professional) by validating ICD, CPT, HCPCS, and DRG codes under the guidance of senior staff.
• Assist with Reviews: Support the customer appeals process by reviewing billed services and assessing their alignment with policies and coding guidelines.
• Policy Research: Monitor payer policies and industry benchmarks to identify potential gaps in the current edit library and suggest improvements.
• Cross-Functional Collaboration: Partner with Product and Engineering teams to assist in testing, troubleshooting, and User Acceptance Testing (UAT) for new and updated rules.
• Documentation: Maintain clear documentation of audit findings and project progress for internal and external stakeholders.

What you bring

• 3+ years of experience in healthcare claims, provider billing, or health plan payment integrity.
• 2+ years as a certified medical coder in a payer, provider, or RCM environment.
• Solid Foundation: Working knowledge of Medicare, Medicaid, and Commercial payer regulations.
• Attention to Detail: Proficiency in auditing for coding accuracy (ICD, CPT, HCPCS, modifiers).
• Analytical Mindset: Ability to review data and identify trends or inconsistencies that impact claim accuracy.
• Communication Skills: Strong written and verbal skills; ability to explain technical coding findings clearly to team members.
• Adaptability: Ready to learn and grow in a fast-paced environment while managing multiple tasks effectively.

Qualifications and core requirements

• Education: Bachelor's degree in Healthcare Administration, Business, or a related field (or equivalent experience).
• Certification: Active medical coding credentials required (CPC, CCS, or CCA).

Pay and benefits

The range listed is for base compensation. Your actual base salary will vary based on factors including location and individual qualifications objectively assessed during the interview process.

In addition to base salary, your total rewards package will include additional components such as incentive pay and benefits. If you're interviewing for this role, speak with your Talent Acquisition Partner to learn more about the specific details for this position.

Base Salary Pay Range $65,000 - $95,000 USD

To support our permanent, full time employees at every stage of their careers and lives, we provide a competitive total rewards and benefits package. Here are the global benefits we'd like to highlight:

• Flexible remote and hybrid working options
• Competitive Salary and a variable component tied to personal and company performance
• Multiple Learning and Development opportunities, including Focus Fridays, a half-day each month to focus on learning and personal growth
• Generous PTO and paid holidays
• Mental health benefits
• 2 MAD Days per year (Make A Difference Days for paid volunteering)

Additional benefits may be offered by country, based on your eligibility - ask your recruiter for more information. Intern and Apprentice positions may receive some of these benefits - ask your recruiter for more details.

AI tools are used to help review applications for this role. Read our AI in Recruitment Notice for what the AI considers, how to request a human review, and our most recent bias audit.

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