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The Senior Clinical Coder serves as a subject matter expert in medical coding and DRG validation, playing a critical role in ensuring coding accuracy, regulatory compliance, and appropriate reimbursement across inpatient and outpatient services. In this role, you will conduct detailed retrospective claims reviews, provide expert-level coding analysis, and support cross-functional teams including medical directors, claims operations, and quality management.

<h2>Role Summary</h2>The Senior Clinical Coder serves as a subject matter expert in medical coding and DRG validation, playing a critical role in ensuring coding accuracy, regulatory compliance, and appropriate reimbursement across inpatient and outpatient services.In this role, you will conduct detailed retrospective claims reviews, provide expert-level coding analysis, and support cross-functional teams including medical directors, claims operations, and quality management. This position is ideal for a highly analytical professional who thrives in a fast-paced, remote environment and is passionate about accuracy, compliance, and continuous improvement in healthcare operations.<hr/><h2>Duties & Responsibilities</h2><ul class="list-disc pl-8"><li>Serve as a subject matter expert for ICD-10-CM, ICD-10-PCS, CPT, and HCPCS coding</li><li>Perform DRG validation and retrospective medical claims reviews</li><li>Analyze inpatient and outpatient claims for coding accuracy and reimbursement determinations</li><li>Prepare clear, detailed determination letters and written review outcomes</li><li>Identify coding discrepancies, potential fraud, and quality concerns</li><li>Provide training, mentorship, and guidance to clinical coding staff</li><li>Collaborate with cross-functional teams to support coding inquiries and review findings</li><li>Research and apply medical policies, benefits, limitations, and current coding guidelines</li><li>Ensure timely completion of coding reviews in alignment with performance standards</li><li>Maintain accurate and thorough documentation within medical management and claims systems</li><li>Escalate complex or high-risk cases to the Medical Director as appropriate</li></ul><hr/><h2>Required Qualifications</h2><ul class="list-disc pl-8"><li>High School Diploma or GED</li><li>Active credential in one of the following:<ul class="list-disc pl-8"><li>Certified Inpatient Coder (CIC)</li><li>Certified Coding Specialist (CCS)</li><li>Registered Health Information Technician (RHIT)</li></ul></li><li>Minimum of five (5) years of clinical coding experience (facility and/or professional)</li><li>Minimum of three (3) years of inpatient and/or outpatient claims processing experience</li><li>Experience working in a fast-paced, production-driven environment</li><li>Ability to obtain and maintain a favorable background investigation</li><li>U.S. Citizenship required</li></ul><hr/><h2>Desired Qualifications</h2><ul class="list-disc pl-8"><li>Experience within managed care, health insurance, or private healthcare industry</li><li>Familiarity with government healthcare programs and regulatory guidelines</li><li>Advanced expertise in inpatient facility coding and DRG validation</li><li>Strong analytical, critical thinking, and problem-solving skills</li><li>High attention to detail with strong organizational capabilities</li><li>Ability to manage large volumes of complex information independently</li><li>Effective communication and collaboration across multidisciplinary teams</li><li>Proficiency in Microsoft Word, Excel, and multi-system environments</li></ul><hr/><h2>Location & Work Type</h2>100% Remote (must reside in an approved state) Full-time position<ul class="list-disc pl-8"><li>Independent home office work environment required</li><li>Prolonged computer use and sitting required</li><li>Flexibility to support varying work schedules as needed</li></ul>

TEEMA Group

Sr. Inpatient Clinical Coder

Analysis Skills

Background Investigation

Certified Coding Specialist (CCS)

Claims Processing

Code Reviews

Communication Skills

Continuous Improvement

Cross-Functional

Current Procedural Terminology (CPT)

Detail Oriented

Diagnosis-Related Group (DRG)

Documentation

Government

Health Insurance

Healthcare

Healthcare Common Procedure Coding System (HCPCS)

Healthcare Software

High School Diploma

ICD-10

Managed Care

Medical Coding

Medical Research

Microsoft Excel

Microsoft Word

Operational Improvement

Operations Management

Organizational Skills

Outpatient Care

Patient Care

Production Systems

Quality Management

Registered Health Information Technician (RHIT)

Regulations

Regulatory Compliance

Reimbursement

Risk

Time Management

United States Citizen

WorkWolf

FULL_TIME

YEAR

At Titan, we are committed to ensuring accurate and timely payments, fostering a collaborative environment where your skills will directly impact our mission of identifying underpayment patterns to maximize revenue recovery for our clients. As a Reimbursement Auditor, you will play a pivotal role in ensuring our clients' claims are processed accurately and identifying areas where additional revenue can be pursued.

Join a dynamic and innovative team dedicated to excellence in healthcare reimbursement. At Titan, we are committed to ensuring accurate and timely payments, fostering a collaborative environment where your skills will directly impact our mission of identifying underpayment patterns to maximize revenue recovery for our clients.    Essential Job Duties/Responsibilities  As a Reimbursement Auditor, you will play a pivotal role in ensuring our clients' claims are processed accurately and identifying areas where additional revenue can be pursued. Your responsibilities will include:   <ul><li>Audit Excellence: Conduct thorough audits of hospital insurance claims payments, including Medicare and Medicaid, ensuring compliance with coding rules and payment standards. Perform in-depth research to verify the accuracy of claim payments or the legitimacy of denials, including proactive communication with insurance plans when necessary. </li><li>Contract Insight: Analyze contract language to identify potential areas for payment errors before they occur, contributing to proactive management of reimbursement processes. </li><li>Error Identification: Detect and verify underpayments by insurance plans, ensuring accurate financial reconciliation for our hospital. </li><li>Appeal Craftsmanship: Develop compelling appeal and grievance arguments, including precise calculations of short payments. Draft and submit appeal letters or reconsideration requests via various channels (phone, fax, email, or payor portal). </li><li>Appeal Management: Review and audit paid appeal amounts to confirm accurate resolution. Draft and submit secondary appeals when necessary, ensuring comprehensive follow-up on underpaid accounts. </li><li>Collaborative Collection: Assist in the collection of appeals by effectively communicating with insurance plans to expedite accurate payments when needed. </li><li>Team Culture: Upholds organizational values to help foster a trusting and respectful work environment. </li></ul>  Minimum Qualifications <ul><li>In-Depth Knowledge: Expertise in Commercial, Medicare, and Medicaid claims, including a thorough understanding of billing, coding rules, and claim forms (UB04 and HCFA 1500) and reimbursement.  Along with, detailed understanding of CPT/HCPCS and ICD10 coding. </li><li>Analytical Skills: Proficiency in contract analysis and interpretation with at least 1 year of experience in contract analysis and hospital or physician claims auditing. </li><li>Appeal Experience: Hands-on experience with payor reconsiderations and appeals, including drafting appeal letters and following up with payors. </li><li>Technical Skills: Proficiency in Microsoft Office (Word and Excel) with at least 1 year of experience. Certification such as Certified Outpatient Coding (COC) or Certified Professional Coding (CPC) is preferred. </li><li>Communication: Exceptional oral and written communication skills, with a focus on customer and client service. </li></ul>  Work Environment <ul><li>Work from home: your workspace should be large enough to work efficiently with reliable internet connectivity.  </li></ul>  Performance Standards <ul><li>Attitude: Demonstrate a positive and professional demeanor toward supervisors, co-workers, and clients. </li><li>Reliability: Show commitment and initiative in your role, with a strong focus on job performance and follow-through. </li><li>Quality: Deliver high-quality work with attention to detail and accuracy. </li></ul>Technical Skills:<ul><li>High school diploma or equivalent.</li><li> Proficiency in Microsoft Office (Word and Excel) with at least 1 year of experience.</li><li>2 years prior experience in reimbursement auditing, contract and financial review. </li><li>CPC-A, CPC preferred</li></ul>Salary Range: $20-25 hourly  Powered by JazzHR

Titan Healthcare Management Solutions

Revenue Cycle Reimbursement Auditor

Auditing

Billing

Centers for Medicare and Medicaid Services (CMS)

Contract Analysis

Contract Review

Customer Relations

Customer Support/Service

Follow Through

Healthcare Reimbursement

Hospital

Insurance

Insurance Claims

Maintain Compliance

Medicaid

Medicare

Microsoft Office

Presentation/Verbal Skills

Process Management

Reconciliation

Revenue Growth

Standards of Care

Team Player

Work From Home

Writing Skills

partner JazzHR

Automation Solution: Design end-to-end automation workflows that integrate modern cloud apps like SharePoint with specific healthcare and data systems including CareRadius, Anchor Point, and Databricks. Design workflows that use Large Language Models to summarize clinical notes or extract data from unstructured provider emails instead of building brittle RPA loops.

HOUR

In this fully remote (select states) Sr Automation Engineer role, you will have the opportunity to join a long-standing healthcare organization, and the timing couldnt be better! Before applying, PLEASE READ: <ul><li>Candidates MUST reside full-time in one of the states listed.</li><li>Candidates MUST be US Citizens</li><li>Candidates MUST be able to receive a favorable Interim and adjudicated final Department of Defense (DoD) background investigation</li><li>Candidates MUST be able to hard wire equipment and have a dedicated work area at home with a door</li><li>Candidates MUST NOT use AI during interviews</li></ul> Company Information: <ul><li>Role open to candidates in the following states: AZ, AK, AR, CO, DC, FL, HI, IA, ID, KS, LA, MD, MN, MO, MT, NE, NV, NM, NC, ND, OK, OR, SC, SD, TN, TX, UT, VA, WA, WI, WY</li><li>Been in operation for over 20 years</li><li>Employs over 1500 Nationwide</li><li>W2 Contract to Perm role</li><li>Hourly depends on location and experience  $72.50 - $79.75</li></ul> Job Summary We are seeking a seasoned Senior Automation Engineer to lead the rapid delivery of high-impact automation solutions within a healthcare payer environment. In this role, you will act as a Lead Developer and Lead Automation Solution Designer. You will be responsible for analyzing complex business workflows in Clinical, Enrollment, Provider, IT Operations and convert them into streamlined, automated processes. You will own the assessment phase to identify repetitive, rules-based tasks that offer the highest ROI and build robust, scalable solutions. You will prioritize modern Generative AI approaches over legacy RPA methods where applicable to reduce maintenance overhead. Key Responsibilities <ul><li>Process Mining and Discovery: Lead workshops with business stakeholders in Enrollment, Provider, Clinical, IT etc to map workflows. Identify manual, repetitive workflows with clear logic and quantify the potential time savings and ROI of automation.</li><li>Automation Solution: Design end-to-end automation workflows that integrate modern cloud apps like SharePoint with specific healthcare and data systems including CareRadius, Anchor Point, and Databricks.</li><li>Generative AI Implementation: Leverage AI tools such as Gemini to replace complex rule-based scraping with intelligent parsing. Design workflows that use Large Language Models to summarize clinical notes or extract data from unstructured provider emails instead of building brittle RPA loops.</li><li>Advanced Development: Build complex, automations using Power Automate Desktop (and similar RPAs) and Cloud Flows. Handle advanced logic, error handling, and exception management using modern AI connectors.</li><li>Governance and Mentorship: Establish coding standards and Secure by Design principles for the automation team. Provide technical guidance and code reviews for the Junior Automation Engineer.</li><li>Integration Strategy: Write custom connectors or scripts using PowerShell, Python, or JSON to bridge gaps where out-of-the-box connectors do not exist.</li></ul> Education and Experience Education: Bachelors degree in Computer Science or a related technical field OR 4 additional years of experience in lieu of degree Experience: <ul><li>8+ years in Software Development or Data Engineering, with a strong emphasis on ETL</li><li>5+ years expert-level proficiency in Microsoft Power Platform including Power Automate Cloud and Desktop. Strong proficiency in API Integration via REST or SOAP and SQL.</li><li>5+ years of extensive experience working with SQL databases, NoSQL environments, and complex API integrations within a healthcare context.</li><li>Proven success in processing large volumes of unstructured medical data using OCR, NLP, and document AI technologies.</li><li>Experience building automated testing frameworks to validate the accuracy of AI outputs in regulated environments.</li><li>Leadership in managing the deployment of bots in virtualized environments and ensuring 24/7 operational stability.</li><li>Demonstrated ability to use Generative AI tools like Gemini, Claude, or OpenAI APIs to solve automation problems. Experience prompting LLMs to structure unstructured data.</li><li>Proven experience automating workflows in a Healthcare Payer setting such as Enrollment processing, Provider Credentialing, or Clinical Prior Authorization.</li></ul> ? Competencies <ul><li>Full Stack Capability: Ability to move seamlessly between low-code environments and pro-code development (Python/C#) as project requirements dictate.</li><li>Data Fluency: Deep understanding of ETL pipelines, data cleaning, and the transformation of unstructured healthcare data into vectorized formats.</li><li>Operational Strategic Thinking: Ability to identify systemic workflow constraints and formulate long-term technical solutions that move beyond simple task automation to create end-to-end autonomous processes.</li><li>Legacy System Navigation: Specialized knowledge in extracting and injecting data into healthcare-specific legacy applications without native API support.</li><li>Performance Tuning: Expertise in optimizing script execution and bot performance to minimize latency and resource consumption.</li></ul>

The Finders

Senior Automation Engineer

Adjudication

Application Programming Interface (API)

Artificial Intelligence (AI)

Automation

Automation Engineering

Business Analysis

Cloud Applications

Cloud Computing

Coding Standards

Computer Science

Data Cleaning

Data Formats

Database Extract Transform and Load (ETL)

Desktop PC

Error Handling

Establish Priorities

Home Automation

JSON

Leadership

Mentoring

Microsoft C# (C Sharp)

Microsoft Product Family

Microsoft SharePoint

Modeling Languages

Natural Language Processing (NLP)

NoSQL

Operational Strategy

Patient Care Authorizations

Performance Tuning/Optimization

Problem Solving Skills

Provider Credentialing

Python Programming/Scripting Language

REST (Representational State Transfer)

Return on Investment (ROI)

SOAP (Simple Object Access Protocol)

SQL (Structured Query Language)

SQL Databases

Scalable System Development

Scripting (Scripting Languages)

Secure Coding

Software Development

Technical Leadership

Test Harness

United States Department of Defense (DoD)

Unstructured Data

Virtualization

Windows PowerShell

Workflow Analysis

HaleyMarketing

ADAPTED_NOW

Our client is a rapidly growing ophthalmology organization that combines decades of clinical excellence with strategic investment. Training Expectations:Tiered Onboarding Options: Tier 1: Onsite for up to 90 days; hybrid after with 1 day/week onsite.

Job Title: Profee Ophthalmology Coder (3 Openings)Location: Phoenix, AZ (must reside in Arizona)Industry: Healthcare Revenue Cycle – Ophthalmology CodingPay: $25 – $31 / hourSchedule: Monday to Friday, 7 AM – 4 PM (AZ time), with 30-minute lunch and two 15-minute breaks (TBD for contractors)Job Type: Contract to hireBenefits: The position is eligible for medical, dental, vision, and 401(k) About Our Client:Our client is a rapidly growing ophthalmology organization that combines decades of clinical excellence with strategic investment. Their mission is to help ophthalmology practices thrive by providing tools, support, and expertise. Job Description:Seeking three experienced professional fee coders for ophthalmology and related specialties. This is a contract-to-hire role with an immediate start and requires AZ residency. Key Responsibilities:<ul><li>Code ophthalmology surgeries and procedures performed in both ASC and clinic settings</li><li>Assign CPT, E/M, and J-codes for ophthalmology, anesthesia, and pain management services</li><li>Handle clinic denials, rebills, and medication codes</li><li>Work with both provider-based and facility-based charges</li><li>Maintain productivity of 55 charts/day with 95% accuracy</li><li>Utilize systems including NextGen (preferred), RVMed, and AAPC Codify</li></ul> Qualifications:<ul><li>AAPC CPC strongly preferred; open to any AAPC or AHIMA certification</li><li>Experience with ophthalmology coding required</li><li>NextGen experience preferred</li><li>Must be adaptable, trainable, and open to feedback</li><li>Must reside in Arizona</li></ul>Additional Details:<ul><li>Start Date: ASAP</li><li>Equipment Provided: Client-issued computer</li><li>Training Expectations:<ul><li>Tiered Onboarding Options: <ul><li>Tier 1: Onsite for up to 90 days; hybrid after with 1 day/week onsite</li><li>Tier 2: Onsite for equipment pickup and walkthrough (flexible on timing)</li><li>Tier 3 (Rare): Fully remote, must provide own equipment & have 15+ years ophthalmology coding experience</li></ul></li></ul></li></ul>Perks:<ul><li>Opportunity for contract-to-hire</li><li>Work with a leading ophthalmology network</li><li>Supportive team environment</li><li>Virtual interviews within 24 hours</li><li>AZ residents prioritized; potential flexibility for seasoned coders</li></ul>Addison Group is an Equal Opportunity Employer. Addison Group provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, gender, sexual orientation, national origin, age, disability, genetic information, marital status, amnesty, or status as a covered veteran in accordance with applicable federal, state and local laws. Addison Group complies with applicable state and local laws governing non-discrimination in employment in every location in which the company has facilities. Reasonable accommodation is available for qualified individuals with disabilities, upon request.  IND 004-008

Need a job? Need an employee? Then you need Addison Group, the professional staffing and search firm that has reshaped the industry with our excellent placements in the Administrative &amp; HR, Engineering, Executive Search, Finance &amp; Accounting, Healthcare, and IT sectors. Addison Group has enjoyed rapid growth since its inception in 1999, when a group of visionary industry leaders in Chicago set out with the simple goal of recruiting the best candidates for the best companies. With the help of its strategic investment partner, Trilantic Capital Partners, Addison Group has expanded its reach across the country through 13 offices and six core industry sectors, from Administrative to IT.

Addison Group

Profee Ophthalmology Coder

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Sr. Inpatient Clinical CoderTEEMA Group

Revenue Cycle Reimbursement AuditorTitan Healthcare Management Solutions

Senior Automation EngineerThe Finders

Profee Ophthalmology CoderAddison Group

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