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Claims Edit Coder Jobs in Florida (NOW HIRING)

Alivi

On-site Medical Claims Examiner

Miami, FL · On-site

... ICD-10 Codes, under the correct provider contract and member benefits. * Responds to provider ... Maintains the department's claim edit rules and processing claims according to client specific ...

Alivi

On-site Medical Claims Examiner

Miami, FL · On-site

... ICD-10 Codes, under the correct provider contract and member benefits. * Responds to provider ... Maintains the department's claim edit rules and processing claims according to client specific ...

Kavaliro

EDI Developer

Orlando, FL · On-site

Understanding of Healthcare revenue & claims life cycle including, escrow, takebacks, overpayments ... Implement and maintain complex validation/edit logic * Translate policy changes into code and data ...

Kavaliro

EDI Developer

Orlando, FL

Understanding of Healthcare revenue & claims life cycle including, escrow, takebacks, overpayments ... Implement and maintain complex validation/edit logic * Translate policy changes into code and data ...

ARC Group

(Full stack) Java/react Developer

Jacksonville, FL · Remote

$48.75 - $62.75/hr

Ability to edit claims in new claims connect application (web-based) JOB SUMMARY: * Must have 5+ ... Experience with unit testing, release procedures, coding design and documentation protocol as well ...

RIZZETTA & COMPANY INC

Clubhouse Manager

Wimauma, FL · On-site

$24 - $25/hr

Only file any claims with the District's insurance company with the prior consent of the District ... Track and code all debit and credit card expenditures. Review all invoices before submitting for ...

Clopay Corporation

Customer Service Representative

Doral, FL

$15.25 - $20.75/hr

Balance daily invoice edit. * Audit open order reports weekly. * Follow up on customers' claims for ... D. accounts, including requisitions for new customer codes. * Assist with furnish and install ...

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All JobsClaims Edit Coder JobsClaims Edit Coder Jobs in Florida

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 Florida? For Claims Edit Coder jobs in Florida, the most frequently searched job titles are:
What job categories do people searching Claims Edit Coder jobs in Florida look for? The top searched job categories for Claims Edit Coder jobs in Florida are:
What cities in Florida are hiring for Claims Edit Coder jobs? Cities in Florida with the most Claims Edit Coder job openings:
Claims Edit Coder jobs near you
Infographic showing various Claims Edit Coder job openings in Florida as of June 2026, with employment types broken down into 91% Full Time, and 9% Part Time. Highlights an 73% In-person, and 27% Remote job distribution.
On-site Medical Claims Examiner

On-site Medical Claims Examiner

Alivi

Miami, FL • On-site

Full-time

Posted 5 days ago

Job description

SUMMARYThis position is intended to provide billing and claims management support to Alivi Specialty Networks and Business Process Outsourcing (BPO) Services.  The Medical Claims Examiner will ensure all claims received comply with all health plan, regulatory, contractual, compliance, and Alivi billing guidelines and processes.DUTIES & RESPONSIBILITIES
  • Responsible for accurate and timely adjudication of professional and institutional claims according to state and federal regulations.
  • Demonstrates knowledge of insurance regulations and policies, payment policies/guidelines and the ability to communicate and work with payers to get claims resolved and paid accurately.
  • Demonstrate skills in problem solving, benefit plan, and provider contract Interpretation.
  • Analyzes, processes, researches, adjusts, and adjudicates claims with the use of accurate procedure/revenue and ICD-10 Codes, under the correct provider contract and member benefits.
  • Responds to provider disputes in a timely and accurate manner.
  • Research provider disputes to ensure appropriate claims dispute resolutions.
  • Works Directly with Clinical Review Board and Network Operations Team to resolve complex issues or disputes.
  • Adjudicates claims that have been overturned by the Clinical Review Board or Network Operations Team. 
  • Generates written correspondence to members, providers, and regulatory agencies.
  • Responds and assists other departments with complex issues for resolution or affirmation of previously processed claims and existing guidelines.
  • Determines and processes overpayments (provider refunds) and reimbursement requests according to specific state and/or federal guidelines or as agreed to in provider contract.
  • Determines and processes underpayments (internal errors) and provider reimbursement requests, which may involve the use of spreadsheet research and correspondence.
  • Maintains the department’s claim edit rules and processing claims according to client specific verification of eligibility, interpretation of program benefits and provider contracts to include manual pricing.
  • Identifies trends in claims flows and suggests process improvements.
  • Assist in preparation with Claims Audits.
  • This position description identifies the responsibilities and tasks typically associated with the performance of the position.
REQUIREMENTS
  • High School diploma or equivalent.
  • 3 years’ work experience in claims operations environment in the healthcare insurance processing Medicare.
  • Hands-on working experience processing medical claims in insurance industry.
  • Knowledge of Medicare Fee Schedule and alternative payment methods (global, cap, flat fees).
  • Self-starter, ability to work independently and in a team environment.
  • Strategic, analytical, process oriented and must have critical thinking skills.
  • Excellent written and verbal communication skills.
  • Ability to manage multiple priorities.
  • Excellent problem-solving skills, good follow-up abilities and willingness to be flexible and adaptable to changing priorities.
  • Works well under pressure.
  • Proficient with Excel, PowerPoint, Word & Outlook.
  • Knowledge of medical terminology and comprehension in the usage of CPT Codes, ICD-10 Codes and Revenue Codes.
  • Knowledge of Correct Coding (CCI) Edits.
  • Experience in gathering all necessary documentation in preparation of Delegation Audits.
  • Detailed knowledge of electronic billing processes universal billing forms.
  • Knowledge of CMS/ACHA Regulations is desirable.
  • Previous Experience using Health Suite is desirable.
    Certified Professional Coder (CPC) is desirable.

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