Senior Specialist, Coding (Remote)

Job Description: The Senior Specialist, Coding Research supports Payment Integrity Prepay operations by researching correct coding edit inquiries, analyzing edit outcomes, validating coding rationale, and monitoring savings and accuracy trends within assigned scope. This role partners with Health Plans, vendors, and internal stakeholders to support consistent application of coding guidelines, timely issue resolution, savings integrity, and accurate claim edit outcomes. Essential Job Duties: - Serve as the primary subject matter expert and Health Plan point of contact for assigned state(s), Health Plans, or edit categories. - Research, analyze, and support correct coding edit accuracy and savings for assigned work. - Apply state, federal, industry, and vendor coding guidance when researching correct coding edit outcomes. - Review edit outcomes and coding rationale to identify inconsistencies, risks, savings impact, and improvement opportunities. - Monitor cod...