Certified Medical Coding Specialist

Shift Technology • Boston, MA

2d • $55,000 - $65,000 • Hybrid

About The Position

Shift is the leading AI platform for insurance. Shift combines generative, agentic, and predictive AI to transform underwriting, 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 when 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 Integrity and Customer Success organization, you will use your technical and clinical coding knowledge to help implement and support solutions that improve claim payment accuracy. Working closely with senior specialists, product, and technical teams, you will help validate edit logic, assist with audits, and identify opportunities to reduce waste and recover overpayments for our customers.

Requirements

• 2+ years of experience in healthcare claims, provider billing, or health plan payment integrity.
• 1+ years as a certified medical coder in a payer, provider, or RCM environment.
• Solid Foundation: Working knowledge of Medicare, Medicaid, and Commercial payer regulations.
• Attention to Detail: Proficiency in auditing for coding accuracy (ICD, CPT, HCPCS, modifiers).
• Analytical Mindset: Ability to review data and identify trends or inconsistencies that impact claim accuracy.
• Communication Skills: Strong written and verbal skills; ability to explain technical coding findings clearly to team members.
• Adaptability: Ready to learn and grow in a fast-paced environment while managing multiple tasks effectively.
• Education: Bachelor’s degree in Healthcare Administration, Business, or a related field (or equivalent experience).
• Certification: Active medical coding credentials required (CPC, CCS, or CCA).
• Work Authorization: Must be authorized to work in the US without employment sponsorship

Responsibilities

• Support Claim Accuracy: Assist in managing pre-pay and post-pay workflows, including claim editing and recovery processes.
• Operationalize Logic: Help define and validate claim edit logic and payment integrity rules to ensure they are functioning correctly for customers.
• Conduct Focused Audits: Perform medical coding audits (inpatient, outpatient, professional) by validating ICD, CPT, HCPCS, and DRG codes under the guidance of senior staff.
• Assist with Reviews: Support the customer appeals process by reviewing billed services and assessing their alignment with policies and coding guidelines.
• Policy Research: Monitor payer policies and industry benchmarks to identify potential gaps in the current edit library and suggest improvements.
• Cross-Functional Collaboration: Partner with Product and Engineering teams to assist in testing, troubleshooting, and User Acceptance Testing (UAT) for new and updated rules.
• Documentation: Maintain clear documentation of audit findings and project progress for internal and external stakeholders.

Benefits

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

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level