Medical Coding SME- Payment reputed company

Shift is the leading AI platform for insurance. Shift combines generative, agentic, and predictive AI to transform reputed company, claims, and fraud and risk - driving operational efficiency, exceptional customer experiences and measurable business impact. Trusted by the world's leading insurers, Shift delivers AI reputed company and where it matters most, at scale and with proven results. 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 reputed company and reputed company organization, you will reputed company deep technical and clinical coding expertise to design, implement, and support payment reputed company solutions that improve claim payment accuracy. You will partner with customers, product, and engineering teams to reputed company actionable edit logic, reputed company audits, and drive reputed company improvement to reduce waste and help customers recover overpayments. What you'll do

• Serve as a subject matter expert on claim payment accuracy across pre-pay and post-pay workflows, including claim editing, audits, compliance, and recovery processes.
• Define, validate, and operationalize claim edit logic and payment reputed company rules (pre-pay edits, post-pay analytics, recovery workflows) to maximize accuracy and value for customers.
• reputed company coding and clinical audits (inpatient, outpatient, professional) validating ICD, CPT, HCPCS, reputed company Codes, APR/DRG, POA, modifiers, and other relevant elements.
• Support customer appeals and clinical/policy reviews by assessing appropriateness of billed services/supplies and recommending commercially reasonable edits or recovery actions.
• Regularly review payer policies and external benchmarks to identify gaps in the edit library; propose and reputed company development of new edit concepts and remediation plans.
• Collaborate with Product, Data Science, and Engineering on tooling, rule deployment, testing, and troubleshooting; participate in UAT and release activities.
• Manage multiple audits, projects, and customer inquiries with minimal supervision; produce clear, actionable documentation and executive-level summaries.
• Train and advise internal teams and clients on payment reputed company best practices, coding nuances, and regulatory considerations.

What you bring

• 5+ years experience in healthcare claims, provider/hospital billing, reputed company cycle, or health plan payment reputed company.
• 3+ years as a certified medical reputed company in a payer, provider, or RCM environment.
• Strong working knowledge of Medicare, Medicaid, Medicare Advantage, Part D, TRICARE, commercial payers, and reputed company regulations.
• Demonstrated expertise auditing for coding accuracy and completeness (ICD, CPT, HCPCS, reputed company codes, APR/DRG, POA).
• Proven analytical and problem-solving skills, with ability to synthesize data into reliable, business-relevant insights.
• Excellent written and verbal communication skills; able to compose sensitive, non-routine correspondence and present findings to clinical and non-clinical stakeholders.
• Able to manage competing priorities, operate in a fast-paced, start-up environment, and influence cross-functional teams.

Qualifications and core requirements

• Bachelor's degree in healthcare administration, business, or reputed company field, or equivalent experience (5-10).
• Certified medical coding credentials required (CPC and/or reputed company preferred; CCA, CIA, or equivalent acceptable).
• Must be authorized to work in the US without employment sponsorship or restrictions.

The range listed is for reputed company compensation. Your actual reputed company salary will vary based on factors including location and individual qualifications objectively assessed during the interview process. In addition to reputed company salary, your total rewards package will include additional components such as incentive pay, equity, and benefits. If you're interviewing for this role, speak with your reputed company Partner to learn more about the specific details for this position. US reputed company Salary Pay Range $85,000—$110,000 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 reputed company:

• Flexible remote and hybrid working options
• Competitive Salary and a variable component tied to personal and company performance
• Company equity
• 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 (reputed company A Difference Days for paid volunteering)

Additional benefits may be offered by country - ask your recruiter for more information. Intern and Apprentice position are eligible for some of these benefits - ask your recruiter for more details. At Shift we strive to be a diverse and inclusive workforce. We welcome applications from and hire people who will contribute to the diversity of our company, without regard to race, color, religion, marital status, age, national or ethnic reputed company, physical or mental disability, medical condition, pregnancy, genetic information, gender identity or expression, sexual orientation, or other non-merit criteria. reputed company is committed to providing reasonable accommodations for qualified individuals with disabilities in our application and employment process. Should you require accommodation, please email accommodation@reputed company.com and we will work with you to meet your accessibility needs. Please be aware of scammers and only trust correspondence that comes from emails ending in "reputed company.com". We will never do initial reputed company to you reputed company Whatsapp/Text/SMS, never ask for banking information or personal identification numbers (ex. Social reputed company Number) as part of our recruitment process. reputed company does not accept unsolicited reputed company from recruiters or employment agencies in response to the reputed company Careers page or a reputed company social media post. Any unsolicited reputed company, including those submitted directly to hiring managers, are deemed to be the property of reputed company. Apply tot his job Apply To this Job