Claims Editing Specialist

Seeking a remote Content Innovation, Claims Editing Specialist focused on specialty pharmacy, this full-time role will source, design, validate, and maintain clinical and coding content for editing products, ensuring accuracy in healthcare payments related to high-cost drugs. Key responsibilities Source and author editing content by interpreting authoritative coding and clinical guidelines Monitor specialty pharmacy drug information and maintain edits for billing and dosing Validate content using claims data to measure accuracy and effectiveness of edits Required qualifications 7+ years of experience in claims editing, clinical coding, or payer policy Active coding credential (e.g., CPC, CCS) or a clinical license with coding experience Deep knowledge of CPT, HCPCS, ICD-10-CM, and reimbursement methodologies Experience with claims data analysis using SQL, Excel, or similar tools At least 3 years of experience with medical benefit drug billing and coding