Claim Review Specialist

About This Claim Review Specialist Role

PARA HealthCare Analytics is hiring for a Claim Review Specialist position connected to Remote (United States) ## Employment Type Full-Time ## Category Medical / Healthcare ## Subcategory Medical Coding Audit ## Additional Categories * Revenue Integrity * Coding Compliance * HIM Audit * Revenue Cycle Consulting * Medical Coding * Healthcare Analytics ## Phone Level Low Phone ## Remote Type Remote (US) ## Job Summary PARA HealthCare Analytics is seeking a Claim Review Specialist to perform outpatient claim audits, review coding accuracy, analyze billing and reimbursement processes, and support revenue cycle consulting initiatives. This role focuses on coding compliance, charge review, reimbursement accuracy, revenue integrity, and regulatory guideline adherence for hospital and professional fee claims.. This Bellencia Career Hub summary translates the original job posting into a structured, easier-to-scan career lead for job seekers comparing remote, hybrid, back-office, healthcare, billing, and administrative opportunities.

The role appears to focus on accurate account work, structured documentation, research, and timely follow-through. Candidates should review the official posting carefully before applying because employer needs, schedules, location rules, and application requirements can change.

Key Responsibilities

Daily Work You May Handle

• Review outpatient and professional fee claims
• Perform coding and billing audits
• Analyze claim accuracy and reimbursement opportunities
• Review CPT, HCPCS, and ICD-10 coding
• Evaluate omitted charges and documentation issues
• Review Medicare and Medicaid compliance requirements
• Analyze NCCI and MUE edits
• Research payer guidelines and reimbursement methodologies
• Develop reports and audit findings
• Participate in client education and presentations

The core workflow centers on accuracy, research, and keeping accounts or records moving through the correct process. A strong applicant should be comfortable reviewing details, comparing information across systems, updating records, and documenting outcomes in a way that supports clean handoffs between departments.

Minimum Requirements

Education, Experience, and Technical Knowledge

• Required
• 5+ years related experience
• CCS, CPC, or COC certification
• Revenue cycle expertise
• Outpatient coding expertise
• Medical terminology knowledge
• Anatomy knowledge
• Strong analytical skills

For this type of role, employers often look for a mix of practical experience, system confidence, and the ability to understand payer, billing, account, or documentation rules. Even when the role is not heavily phone-based, communication still matters because the work may involve coordination with internal teams, management, or partner departments.

Phone Level and Work Style

Bellencia phone-level estimate: Non-phone. This classification is based on the wording in the pasted posting. Because this is an estimate, applicants who need non-phone or low-phone work should confirm phone expectations during the interview. The posting reads most strongly as Revenue Cycle work with a focus on written records, account review, payer details, research, and follow-up.

Pay, Schedule, and Location Details

Pay: not listed in the pasted posting. Schedule: not clearly listed. Job type: Full-time. Location or work arrangement: Remote (United States) ## Employment Type Full-Time ## Category Medical / Healthcare ## Subcategory Medical Coding Audit ## Additional Categories * Revenue Integrity * Coding Compliance * HIM Audit * Revenue Cycle Consulting * Medical Coding * Healthcare Analytics ## Phone Level Low Phone ## Remote Type Remote (US) ## Job Summary PARA HealthCare Analytics is seeking a Claim Review Specialist to perform outpatient claim audits, review coding accuracy, analyze billing and reimbursement processes, and support revenue cycle consulting initiatives. This role focuses on coding compliance, charge review, reimbursement accuracy, revenue integrity, and regulatory guideline adherence for hospital and professional fee claims.. Applicants should verify the official application page for the most current pay range, benefits, shift expectations, equipment rules, and state eligibility requirements.

Best-Fit Applicant Profile

This role may be a good match for someone who enjoys detailed, process-driven work and can stay consistent with repetitive but important tasks. It may fit job seekers with experience in medical billing, revenue cycle, accounts receivable, claims, refunds, charge capture, payer research, payment posting, documentation review, insurance eligibility, or healthcare administrative support.

• You are comfortable researching account details and correcting issues before they become larger problems.
• You can follow written procedures and keep documentation clean, accurate, and audit-ready.
• You prefer structured back-office work over sales-driven or heavy call-center duties.
• You can manage confidential information professionally and escalate unclear issues when needed.

Resume Keywords to Consider

Relevant resume keywords may include Claim Review Specialist, Medical / Healthcare, Revenue Cycle, Insurance Verification, Coding, Refund Processing, Revenue Integrity, Medical Records / HIM, documentation, account research, workflow queues, Excel, payer requirements, reconciliation. Use only the keywords that honestly match your experience. The strongest applications usually connect past duties directly to the employer’s listed responsibilities.

How to Apply

Use the official application link for this job posting when you are ready to apply. Before submitting, review the required experience, confirm the schedule, and tailor your resume summary and bullet points toward the highest-priority duties in this listing.