Part-time Biller/Coder - Claims Analyst

OVERVIEW

Part-time Biller/Coder - Claims Analyst
Location: Remote

Vital Incite, an Alera Group company, is looking to add an experienced Biller/Coder - Claims Analyst to their team on a part-time basis (approximately 5-8 hours per week with flexible scheduling).
About Alera Group
Alera Group was founded in 2017 and has grown to become the 14th largest broker of U.S. business. We are passionate about our clients' success in the areas of Employee Benefits, Property and Casualty Insurance, and Financial Services. With a network of offices nationwide, our commitment to collaboration allows us to offer national resources combined with local service.
Why Alera Group

• Make an Impact: Your work supports businesses and individuals in protecting what matters most.
• Grow With Us: We invest in development, mentorship, and long-term career growth.
• The Collaborative Way: We believe in accountability, teamwork, and shared success across all offices and lines of business.
• National Strength. Local Heart: Scale, resources, and expertise - with relationships that feel personal.

RESPONSIBILITIES

Position Summary

The Part-time Biller/Coder - Claims & Alert/Trigger Criteria supports Vital Oversight's continuous monitoring of medical and pharmacy claims by reviewing claims for coding accuracy and reimbursement appropriateness and by developing and maintaining alert and trigger logic that identifies high-risk or outlier claims. This role works collaboratively with claims, clinical, and oversight stakeholders to surface actionable findings that support proactive cost and payment integrity oversight.

What You'll Do / Your Impact

Claims Review & Payment Integrity

• Review medical and/or pharmacy claims to validate coding accuracy, billed services, and reimbursement appropriateness.
• Identify potential coding errors, modifier misuse, payment discrepancies, and outlier reimbursement patterns.
• Document clear findings and rationale to support carrier or PBM follow-up and recovery efforts.
• Collaborate with claims specialists and clinical stakeholders to ensure findings are actionable.

Alert & Trigger Criteria Development

• Develop and maintain trigger logic that identifies high-risk or outlier claims, including cost thresholds by CPT, HCPCS, J-code, or episode of care.
• Design triggers for emerging risk patterns such as modifier trends, unusual line splitting, or place-of-service cost anomalies.
• Document trigger specifications, including logic, thresholds, rationale, and examples.
• Perform quality checks on trigger output to reduce false positives and improve signal quality.

Documentation & Communication

• Conducts oneself with a high degree of integrity and professionalism.
• Creates and maintains positive working relationships through trust, dependability, and collaboration.
• Demonstrates strong attention to detail and accountability for accuracy.
• Works independently with strong time management and organization skills.
• Communicates clearly and effectively in written documentation.
• Demonstrates a continuous improvement mindset aligned with Oversight goals.

QUALIFICATIONS

What You Bring

Required

• Credentials - Active billing/coding credential such as CPC, CCS, CCS-P, RHIA, RHIT, or equivalent
  
• Experience - 3+ years of experience in medical billing, coding, or claims review

Preferred Experience

• Payment integrity, audits, or overpayment recovery
  
• High-cost claims and specialty drug billing
  
• Designing rules, edits, or analytics-driven claim flags

ADDITIONAL INFORMATION

Compensation:
Hourly range: $50 - $65 per hour

Benefits:
Alera Group offers comprehensive benefits including medical, dental, vision, life and disability coverage, 401(k), generous PTO, and more.

Work Model:
Remote, Part-time, approximately 5-8 hours per week with flexible scheduling

Professional Development - Alera Group Academy

At Alera Group, growth isn't left to chance. Through Alera Group Academy, we provide structured development opportunities designed to help you expand your expertise and build a meaningful career.

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