Part-time Biller/Coder - Claims AnalystAlera Group, Inc. • New York, New York, United States
Part-time Biller/Coder - Claims Analyst
Alera Group, Inc.
- New York, New York, United States
- New York, New York, United States
À propos
Make an Impact: Your work supports businesses and individuals in protecting what matters most. Grow With Us: We invest in development, mentorship, and long-term career growth. The Collaborative Way: We believe in accountability, teamwork, and shared success across all offices and lines of business. National Strength. Local Heart: Scale, resources, and expertise — with relationships that feel personal.
Responsibilities Position Summary The Part-time Biller/Coder – Claims & Alert/Trigger Criteria supports Vital Oversight's continuous monitoring of medical and pharmacy claims by reviewing claims for coding accuracy and reimbursement appropriateness and by developing and maintaining alert and trigger logic that identifies high-risk or outlier claims. This role works collaboratively with claims, clinical, and oversight stakeholders to surface actionable findings that support proactive cost and payment integrity oversight. What You'll Do / Your Impact Claims Review & Payment Integrity
Review medical and/or pharmacy claims to validate coding accuracy, billed services, and reimbursement appropriateness. Identify potential coding errors, modifier misuse, payment discrepancies, and outlier reimbursement patterns. Document clear findings and rationale to support carrier or PBM follow-up and recovery efforts. Collaborate with claims specialists and clinical stakeholders to ensure findings are actionable.
Alert & Trigger Criteria Development
Develop and maintain trigger logic that identifies high-risk or outlier claims, including cost thresholds by CPT, HCPCS, J-code, or episode of care. Design triggers for emerging risk patterns such as modifier trends, unusual line splitting, or place-of-service cost anomalies. Document trigger specifications, including logic, thresholds, rationale, and examples. Perform quality checks on trigger output to reduce false positives and improve signal quality.
Documentation & Communication
Conducts oneself with a high degree of integrity and professionalism. Creates and maintains positive working relationships through trust, dependability, and collaboration. Demonstrates strong attention to detail and accountability for accuracy. Works independently with strong time management and organization skills. Communicates clearly and effectively in written documentation. Demonstrates a continuous improvement mindset aligned with Oversight goals.
Qualifications What You Bring Required
Credentials – Active billing/coding credential such as CPC, CCS, CCS-P, RHIA, RHIT, or equivalent Experience – 3+ years of experience in medical billing, coding, or claims review
Preferred Experience
Payment integrity, audits, or overpayment recovery High-cost claims and specialty drug billing Designing rules, edits, or analytics-driven claim flags
Additional Information Compensation: Hourly range: $50 – $65 per hour Benefits: Alera Group offers comprehensive benefits including medical, dental, vision, life and disability coverage, 401(k), generous PTO, and more. Work Model: Remote, Part-time, approximately 5–8 hours per week with flexible scheduling Professional Development – Alera Group Academy At Alera Group, growth isn't left to chance. Through Alera Group Academy, we provide structured development opportunities designed to help you expand your expertise and build a meaningful career. You'll have access to:
Role-specific learning paths Leadership development programs Technical and compliance training Industry certifications and continuing education support Peer learning and knowledge-sharing communities
Whether you're deepening technical expertise or preparing for leadership, we're invested in helping you grow. We're an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status, or any other protected class. Alera Group is committed to protecting your privacy. Please review our Privacy Policy to understand what personal information we may collect and use as part of your application process. Location Type: Remote
Compétences linguistiques
- English
Avis aux utilisateurs
Cette offre provient d’une plateforme partenaire de TieTalent. Cliquez sur « Postuler maintenant » pour soumettre votre candidature directement sur leur site.