Senior Medical Coding Specialist- WC Experience

Senior Medical Coding Specialist (Workers’ Compensation Experience Required)

At Claritev, we pride ourselves on being a dynamic team of innovative professionals. Our purpose is simple – we strive to bend the cost curve in healthcare for all. Our dedication to service excellence extends to all stakeholders, both internal and external, driving us to consistently exceed expectations. We are intentionally bold, we foster innovation, we nurture accountability, we champion diversity, and empower each other to illuminate our collective potential.

Be part of our transformational journey as we continue to evolve into a leading technology, data, and innovation voice in healthcare. Onward and Upward!!!

Job Summary

The Senior Medical Coding Specialist is responsible for analyzing high-dollar, complex claims by applying advanced coding knowledge, research, and regulatory standards to ensure accurate billing practices. This role plays a critical part in identifying billing discrepancies, ensuring compliance, and supporting both domestic and global coding operations.

This position requires strong expertise in Workers’ Compensation claims, as well as the ability to apply both U.S. and international coding standards in a fast-paced, high-impact environment.

Key Responsibilities

• Review and analyze complex inpatient, outpatient, and practitioner claims for medical appropriateness and billing accuracy
• Evaluate charges across revenue centers, considering diagnosis, procedures, patient demographics, and facility type
• Apply national and international coding standards to ensure compliance and accuracy
• Support daily operations and departmental processes in partnership with leadership
• Facilitate claim review discussions, including complex case reviews and feedback sessions
• Design and deliver coding education, training, and mentorship for new and existing team members
• Serve as a subject matter expert (SME) for clinical and coding-related questions
• Monitor turnaround times and recommend process improvements to increase efficiency
• Research claims, trends, itemized bills, operative notes, and supporting documentation
• Collaborate with physician and analytics teams to enhance coding edits, guidelines, and best practices
• Communicate coding, clinical, and reimbursement findings clearly to internal stakeholders
• Assist in evaluating team performance and supporting staff development initiatives
• Contribute to department goals, process improvements, and strategic initiatives
• Ensure compliance with HIPAA and applicable international data protection regulations

Please note: due to the exposure of PHI sensitive data, this role is considered to be a High Risk Role.

Compensation

The salary range for this position is $70-90k annually.  Specific offers take into account a candidate’s education, experience and skills, as well as the candidate’s work location and internal equity.  This position is also eligible for health insurance, 401k and bonus opportunity.

Job Scope

This role operates independently with minimal supervision, managing complex and varied workloads. The Senior Medical Coding Specialist applies deep industry knowledge and sound judgment to resolve issues, while escalating highly complex cases as needed. Success in this role requires strong analytical skills, attention to detail, and the ability to balance multiple priorities in a deadline-driven environment.