Content Innovation, Claims Editing

. Monitor and interpret CPT, HCPCS, ICD-10-CM, NCCI, MUE, CMS, specialty society, payer, and New York Medicaid sources .

Posted 10/15/2026full-timeRemote • United StatesSeniorLead💰 $135,000 - $165,000 per yearWebsite

Tools & technologies

SQL

Key responsibilities & impact

Monitor and interpret CPT, HCPCS, ICD-10-CM, NCCI, MUE, CMS, specialty society, payer, and New York Medicaid sources
Translate coding rules, clinical guidelines, and reimbursement policy into precise, testable editing logic
Document edit sources, rationale, and scope for traceability and appeals
Separate portable market-wide content from client-specific policy
Maintain content through code updates, policy changes, and performance reviews
Build New York Medicaid content for Mainstream Managed Care, HARP, behavioral health, FQHC, and long-term care services
Use claims data to test concepts, size opportunities, and estimate hit rates, false positives, and savings
Review production results and track accuracy, appeals, overturns, provider abrasion, and realized savings
Partner with Product, Engineering, and Data Science on requirements, logic specifications, test cases, and AI-assisted content workflows
Explain content rationale and impact to clients and internal teams; support policy review, approvals, and appeals
In the first 90 days, learn the content portfolio and deliver a prioritized list of New York content gaps and opportunities
Within 6–12 months, own a content domain, move data-validated concepts into production, maintain documentation, improve content-building processes, and demonstrate measurable results

What you’ll need

7+ years of experience in claims editing, clinical coding, Payment Integrity, or payer policy, with hands-on experience authoring or validating edits
Active coding credential, such as CPC, CCS, CCS-P, CPMA, or CIC, or a clinical license such as RN paired with deep coding experience
Deep, current knowledge of CPT, HCPCS, ICD-10-CM, modifiers, NCCI, MUEs, coding guidelines, and documentation requirements
Working knowledge of reimbursement methodologies, including fee schedules, DRGs, APCs, and professional and facility billing
Experience sourcing and interpreting CMS manuals, NCDs and LCDs, AMA guidance, and payer policies
Strong analytical skills and comfort working with claims data, using SQL, Excel, or similar tools
Experience working with Product, Engineering, Data Science, or other multidisciplinary teams
Clear written communication and ability to explain complex coding and clinical logic to nonclinical audiences
Curiosity about AI tools and willingness to use them in daily content work
At least 3 years of experience with New York State Medicaid policy, billing, or Payment Integrity, including eMedNY, APGs, APR-DRGs, and NYS DOH and OMIG guidance
Sound judgment and comfort working in a fast-moving build-and-scale environment

Comp & perks