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Claims Edit Coder Jobs in Florida (NOW HIRING)

Coral Connect LLC

Billing Specialist

Boca Raton, FL · On-site +1

$18.25 - $24.75/hr

This role ensures claims are billed in accordance with payer requirements, coding guidelines ... Claim Edit & Rejection Management * Monitor clearinghouse and payer claim edits. * Research and ...

Coral Connect LLC

Billing Specialist

Boca Raton, FL · Remote

$18.25 - $24.75/hr

This role ensures claims are billed in accordance with payer requirements, coding guidelines ... Claim Edit & Rejection Management * Monitor clearinghouse and payer claim edits. * Research and ...

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 ...

Skin Wellness Physicians

Medical Billing Specialist

Naples, FL · On-site

$17.25 - $22.25/hr

... and edit, insurance follow up, patient balance follow up, denials, transfers to patient balance ... Assists with coding and billing error resolution for all practice locations. * Submit claims ...

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 ...

Hatalom

Contracts Manager

Orlando, FL · On-site

$77K - $103K/yr

Resolve issuesregardingcontractual performance, including claims, changes, and terminations ... Drafts contractual agreements and subcontracts; edit terms and conditions and flow-down ...

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All JobsClaims Edit Coder JobsClaims Edit Coder Jobs in Florida

Claims Edit Coder information

What is a claims edit coder?

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 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 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 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 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 August 2026, with employment types broken down into 95% Full Time, and 5% Part Time. Highlights an 77% In-person, and 23% Remote job distribution.

Revenue Cycle & Claims Operations Lead

Pompano Beach, FL • On-site, Remote

Porter Cares, Inc.
See more jobs at Porter Cares, Inc.external

Full-time

Re-posted 28 days ago

Job description

Porter is hiring a Revenue Cycle & Claims Operations to join our Team!
Porter combines the power of analytics with the power of care. Porter is a leading healthcare IT and services platform for care and coverage coordination that optimizes outcomes and member experience. We deliver understanding, compassion, information, and peace of mind for your members. Driven by robust AI analytics, Porter's Care Guide team helps the member navigate the healthcare delivery system, secures the right support for each member's specific needs, and directs Porter's team of expert clinicians to perform comprehensive in-home assessments, complete with lab and diagnostic testing. By coordinating the complexities of each unique care journey, Porter helps close the gaps with the largest impact on quality measures, total cost of care, risk adjustment, and member experience.
ABOUT THE ROLE
Our organization operates in a payer-contracted services model - including delegated services, in-home assessments, HEDIS gap closure, and risk adjustment visits - rather than traditional fee-for-service care. Our billing patterns vary by payer and may include "penny claims" for encounter reporting paired with separate plan invoicing, or full-cost claims billed at the full contracted (allowable) rate.
Our EMR/RCM platform, Athena, is built around traditional fee-for-service economics: maximizing collections, flagging low-dollar claims as errors, and defaulting to standard allowable-amount and co-insurance logic. This creates a persistent structural mismatch with our billing model.
We are hiring a Revenue Cycle & Claims Operations Lead to own this problem end-to-end: to understand our payer contracts and billing models deeply, to configure and manage Athena as effectively as the platform allows, to build the reporting infrastructure needed to see what's actually happening to our claims, and to make a clear, well-supported recommendation on whether our long-term path is continued mitigation within Athena or migration to a different platform.
KEY RESPONSIBILITIES
Athena Configuration & Payer Alignment
  • Serve as the primary internal owner of Athena claim edit rules, hold queues, and workflow configuration as they relate to our non-FFS billing model.
  • Partner directly with Athena's professional services / support team to build and maintain custom rules that suppress inappropriate low-dollar ("penny claim") edits and prevent unwanted allowable-amount or co-insurance recalculation on contracts where the full billed amount is the contracted rate.
  • Translate payer contract terms (rate structures, encounter-reporting requirements, invoicing arrangements) into correct system configuration.
  • Maintain a living documentation set of every custom rule, workaround, and configuration decision made in Athena, including rationale and payer applicability.

Claims Operations & Oversight
  • Ensure claims are reaching payers as intended and reconcile discrepancies between what was submitted, what was accepted, and what was paid or invoiced.
  • Identify and clear inappropriate Athena holds; distinguish true data/coding issues from false positives generated by FFS-oriented logic.
  • Track and resolve partial payments, particularly where Athena's allowable-amount logic conflicts with contracted full-payment terms.
  • Oversee the separate plan-invoicing process for encounter/penny-claim arrangements, ensuring invoices reconcile against submitted encounters.

Reporting & Analysis
  • Design and maintain recurring reports covering: claim submission status, current holds and aging, partial payment / underpayment tracking, and payer-specific exception trends.
  • Direct and review the work of the Billing & Claims Analyst in building and running these reports.
  • Surface patterns (e.g., a hold type recurring across many claims for one payer) and use them to drive systemic fixes rather than one-off corrections.

Strategic Recommendations
  • Lead a structured 90-day assessment of Athena's fit for our billing model (see companion scoping document) and deliver a clear recommendation: continue to mitigate within Athena, or scope a transition to an alternative platform.
  • If migration is recommended, lead requirements-gathering and RFP scoping for a replacement EMR/RCM system suited to delegated/value-based billing models.
  • Proactively bring forward recommendations - process changes, payer conversations, system configuration, or staffing - rather than waiting to be asked.

REQUIRED QUALIFICATIONS
  • 5+ years of revenue cycle management or claims operations experience in healthcare.
  • Direct, hands-on experience with value-based care, risk adjustment, HEDIS/quality gap closure, delegated services, or other non-fee-for-service payer arrangements -
  • Practical experience configuring Athena (or a comparable EMR/RCM platform), including working with vendor support/professional services teams on custom edit rules and workflow changes.
  • Ability to read and interpret payer contract language and translate contractual terms into system requirements.
  • Strong analytical and reporting skills; comfortable building reconciliation reports and communicating findings to finance leadership.
  • Demonstrated ability to work cross-functionally with finance, operations, and external vendor teams, and to advocate persistently when a vendor's default assumptions don't fit the business model.

PREFERRED QUALIFICATIONS
  • Prior experience evaluating or migrating between EMR/RCM platforms.
  • Familiarity with encounter data reporting standards and delegated/capitated payer relationships.
  • Certification such as CRCR (Certified Revenue Cycle Representative) or equivalent.
  • Experience managing or mentoring junior billing/claims staff.

$115,000 - $150,000 a year
COMPENSATION & BENEFITS
Competitive wage and benefits package.
Opportunities for professional growth and continuing education.
A supportive, collaborative work environment.
We may use artificial intelligence (AI) tools to support parts of the hiring process, such as reviewing applications, analyzing resumes, or assessing responses and identifying potential inconsistencies or verification signals in application materials based on available information. These tools assist our recruitment team but do not replace human judgment. Final hiring decisions are ultimately made by humans. If you would like more information about how your data is processed, please contact us.

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