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Claims Edit Coder Jobs in Delaware (NOW HIRING)

Claims Edit Coder information

What are the key skills and qualifications needed to thrive as a Claims Edit Coder, and why are they important?

To thrive as a Claims Edit Coder, you need a solid understanding of medical coding (ICD-10, CPT, HCPCS), claims processing, and healthcare regulations, typically supported by a coding certification such as CPC or CCS. Familiarity with electronic health record (EHR) systems, claims editing software, and payer-specific coding guidelines is crucial. Attention to detail, analytical thinking, and effective communication are vital soft skills for accurately identifying and resolving coding errors. These skills ensure correct claim submission, minimize denials, and support timely reimbursement for healthcare providers.

What are Claims Edit Coders?

Claims Edit Coders are healthcare professionals who review and analyze medical claims to ensure they are coded accurately and comply with insurance and regulatory guidelines. They use specialized coding systems, such as ICD-10, CPT, and HCPCS, to verify that procedures and diagnoses are properly documented. Their work helps prevent billing errors, reduce claim denials, and ensure timely reimbursement for healthcare providers. Claims Edit Coders often collaborate with billing departments and healthcare providers to resolve discrepancies and improve coding accuracy.

What is the difference between Claims Edit Coder vs Claims Processing Specialist?

AspectClaims Edit CoderClaims Processing Specialist
CertificationsCertified Coding Associate (CCA), CPCNone required, but certifications can be beneficial
Work EnvironmentHealthcare facilities, insurance companies, remoteInsurance companies, healthcare providers, office setting
Primary ResponsibilitiesReview and correct claim data, ensure coding accuracyProcess claims from submission to payment, handle inquiries

Claims Edit Coders focus on reviewing and correcting claim data to ensure accurate coding, while Claims Processing Specialists handle the overall processing of claims from submission to resolution. Both roles require knowledge of insurance policies and coding, but Claims Edit Coders are more specialized in coding accuracy, whereas Claims Processing Specialists manage broader claim workflows.

What are some common challenges faced by a Claims Edit Coder, and how can they be addressed?

Claims Edit Coders often encounter challenges such as staying updated with frequent changes in coding regulations and payer-specific requirements. Additionally, coding errors or discrepancies may arise due to incomplete or unclear documentation from providers. To address these issues, it's important to engage in ongoing education, actively communicate with clinical staff for clarification, and utilize reliable coding resources and software. Collaboration with team members and regular training can help maintain accuracy and compliance in claim submissions.
What are popular job titles related to Claims Edit Coder jobs in Delaware? For Claims Edit Coder jobs in Delaware, the most frequently searched job titles are:
What cities in Delaware are hiring for Claims Edit Coder jobs? Cities in Delaware with the most Claims Edit Coder job openings:
US Medical Early Asset Director - Market Access

US Medical Early Asset Director - Market Access

AstraZeneca

Wilmington, DE

Full-time

Posted 28 days ago


AstraZeneca rating

8.6

Company rating: 8.6 out of 10

Based on 43 frontline employees who took The Breakroom Quiz

16th of 71 rated pharmaceutical


Job description

US Medical Early AssetDirector- Market Access

Are you ready to turn ideas into life-changing medicines? At AstraZeneca, we are committed to addressing the unmet needs of patients worldwide through scientific innovation. In this role, you will play a crucial role inleveragingour scientific capabilities to positively impact patients' lives. Reporting directly to theHead of US Medical Early Asset Team Lead, you willbe part of a teamfocused on the development of ambitious US medical strategies for our early pipeline. This is an opportunity to seize, design, and influence across a complex matrix system to ensure US needs are integrated into global development plans.

Accountabilities:
TheUS Medical Early Asset Director - Market Accesswill shape the US access strategy for pipeline assets from late discovery through Phase 2. You will translate emerging science into payer-relevant value, inform clinical and evidence plans, and ensure US access needs are embedded in global asset strategy. Partnering closely with Global/US Market Access, HEOR, Medical, Clinical Development, Commercial, and Finance, you will define early payer value propositions, evidence requirements, pricing and contracting hypotheses, and policy risk mitigation to de-risk reimbursement at launch.

Key Responsibilities

  • US Value Strategy and TPP Input: Define US payer-relevant elements of theTarget Product Profile(clinical endpoints, comparators, subpopulations, line of therapy) and shape differentiation claims that resonate with payers and health systems.

  • Evidence and Study Design Influence: Provide US access input to clinical and RWE plans (endpoints, PROs, inclusion/exclusion, duration, head-to-heads, external controls) to support label, compendia, guideline inclusion, and payer coverage.

  • Payer Value Proposition & Dossier Foundations: Lead early value story development (unmet need, clinical and economic value drivers), outline core claims, and define requirements for future AMCP dossier modules and global value dossiers.

  • Early Pricing and Contracting Hypotheses: Develop US WAC/NET ranges, reference pricing considerations, budget impact boundaries, and contracting scenarios (e.g., outcomes-based, indication-based) with assumptions and risks.

  • HEOR & RWE Strategy: Co-create early economic models and RWE plans (burden of illness, treatment patterns, comparative effectiveness, adherence/persistence) to support access and inform trial design.

  • Access Policy and Channel Strategy: Assess policy landscape (Medicare, Medicaid, ACA, IRA/Part D redesign, 340B, state policies), site-of-care and channel dynamics (buy-and-bill, pharmacy benefit, specialty distribution), and implications for design and launch.

  • Payer, IDN, and PBM Insights: Plan and synthesize early payer/IDN advisory input and rapid tests (concept reviews, value message testing, coverage criteria simulations) to de-risk access hurdles.

  • Competitive and Class Access Analytics:Maintainlandscape of class coverage criteria, step/edit rules,utilizationmanagement, coding/reimbursement precedents;identifyopportunities to differentiate andanticipatebarriers.

  • Forecasting & Investment Support: Build access assumptions for early forecasts (gross-to-net, access mix, UM intensity, speed-to-coverage) and partner with Finance onrNPV/scenario analyses for governance.

  • Governance and Cross-Functional Leadership: Represent US access in global/US asset teams and at governance gates (indicationsequencing, go/no-go, TPP approval), driving clear, evidence-backed recommendations.

  • Compliance and Ethics:Operatewithin US promotional and pre-approval communication standards and company policies; ensure research and external interactions meet compliance requirements.

MinimumQualifications

  • Education: Bachelor's degreerequired; advanced degree preferred (MPH, MS HEOR, PharmD, MBA, or related).

  • 5+years inpharmaceuticalor consultancy with a focus on US market access/HEOR; experienceinfluencing early development (Phase 1-2)stronglypreferred.

  • Demonstrated impact shaping TPPs, clinical design/evidence to meet payer needs, and developing early value propositions and pricing/contracting hypotheses.

  • Ability to translate clinical profiles into payer-relevant value andcoveragedrivers.

  • Comfort interpreting economic models, burden of illness, and RWE methodologies; able to brief modeling teams and stress-test assumptions.

  • Working knowledge of Medicare/Medicaid, commercial payers, PBMs, 340B, medical vs. pharmacy benefit dynamics, coding/billing, and site-of-care economics.

  • Experience designing and synthesizing payer research, advisory boards, and message testing.

Preferred Qualifications

  • Proven ability to lead without authority across Clinical, Medical, HEOR, Commercial, and Finance.

  • Clear, concise storyteller able to craft payer narratives and present to governance and senior stakeholders.

  • Strong quantitative skills; scenario analysis and sensitivity testing to inform investment decisions.

  • Operates in ambiguity, manages multiple assets, and meets fast-paced milestone timelines.

This position is based at our Wilmington, DE campus headquarters for our US Biopharma business.When we put unexpected teams in the same room, we unleash bold thinking with the power to inspire life-changing medicines. In-person working gives us the platform we need to connect, work atpaceand challenge perceptions.That'swhy we work, on average, a minimum of three days per week from the office. But thatdoesn'tmeanwe'renot flexible. We balance the expectation of being in the office while respecting individual flexibility. Join us in our unique and ambitious world.

Next Steps - Apply Today!

Are you ready to make a difference? Apply now and join our mission to transform lives with our science!

Date Posted

03-Jun-2026

Closing Date

29-Jun-2026

Our mission is to build an inclusive environment where equal employment opportunities are available to all applicants and employees. In furtherance of that mission, we welcome and consider applications from all qualified candidates, regardless of their protected characteristics. If you have a disability or special need that requires accommodation, please complete the corresponding section in the application form.


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