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Claims Edit Coder Jobs in Texas (NOW HIRING)

MMC Group

DRG Auditor

San Antonio, TX · Remote

Utilize proper reference material, standards, and guidelines for coding. * Provide input to the Edit Development team on claims selection criteria. * Verify data received from client and work to ...

Clopay

Customer Service Representative

Carrollton, TX · On-site

$15.50 - $21/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 ...

Clopay

Customer Service Representative

Carrollton, TX · On-site

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 ...

Clopay

Customer Service Representative

Carrollton, TX · On-site

$15.50 - $21/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 ...

City of El Paso

Assistant City Attorney II

El Paso, TX

$106K - $140K/yr

Requirements MOS Code: 2505 (Navy) Education and Experience: Law Degree and four (4) years ... Receive and review claims and lawsuits filed against the City; assist and represent the City in its ...

City of El Paso, TX

Assistant City Attorney I

El Paso, TX · On-site

$86K - $119K/yr

Exempt Requirements MOS Code: 2505 (Navy) Education and Experience: Law Degree Licenses and ... Receive and review claims and lawsuits filed against the City; assist and represent the City in its ...

City of El Paso

Assistant City Attorney I

El Paso, TX

$86K - $119K/yr

Requirements MOS Code: 2505 (Navy) Education and Experience: Law Degree Licenses and Certificates ... Receive and review claims and lawsuits filed against the City; assist and represent the City in its ...

City of El Paso, TX

Assistant City Attorney II

El Paso, TX · On-site

$106K - $140K/yr

Exempt Requirements MOS Code: 2505 (Navy) Education and Experience: Law Degree and four (4) years ... Receive and review claims and lawsuits filed against the City; assist and represent the City in its ...

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All JobsClaims Edit Coder JobsClaims Edit Coder Jobs in Texas

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 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 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 Texas? For Claims Edit Coder jobs in Texas, the most frequently searched job titles are:
What job categories do people searching Claims Edit Coder jobs in Texas look for? The top searched job categories for Claims Edit Coder jobs in Texas are:
What cities in Texas are hiring for Claims Edit Coder jobs? Cities in Texas with the most Claims Edit Coder job openings:
Claims Edit Coder jobs near you
Infographic showing various Claims Edit Coder job openings in Texas as of August 2026, with employment types broken down into 99% Full Time, and 1% Part Time. Highlights an 77% In-person, and 23% Remote job distribution.

DRG Auditor

MMC Group

San Antonio, TX • Remote

Full-time

Re-posted 18 days ago

Job description


Job Description:

A leader in providing clinical auditing services to public and commercial healthcare payers throughout the US, has openings for remote DRG Validation Auditors. As members of the DRG Validation Team and working remotely, incumbents will be responsible for reviewing medical records to determine the accuracy of coding and reimbursement for clinical services rendered to beneficiaries of various health plans, including Commercial, Medicare, and Medicaid Clients. DRG Validation Auditors are charged with rendering appropriate, well-supported, and thoroughly-documented decisions, which may result in identification of improper payments (overpayments and underpayments) on paid claims on behalf of the client from various providers of clinical services, including but not limited to acute care, long-term acute care, acute rehabilitation, and skilled nursing facilities, as well as other provider types and care settings. Initially, DRG Validation Auditors are prepared for the role through a detailed, well-defined training process, gaining knowledge and skills in methods for review of medical records and other provider documentation. Ongoing training and education are provided specific to audit processes, coding and reimbursement changes, and other topics as well. The DRG Validation Auditor reports to a DRG Validation Team Leader, who provides support, feedback, and guidance to DRG Validation Auditors. Moreover, quality assurance is provided through a well-defined review and quality management program performed by the Professional Development Team.


Specifically, DRG Validation Auditors will be responsible for the following:


  • Review inpatient medical records to validate the admit order, assignment and sequencing of ICD9-CM diagnosis and procedure codes, discharge status codes, and DRG assignment.

  • Provide a detailed rationale for every medical record review resulting in a DRG Review Results letter, including supporting references.

  • Follow proper procedure for referral to Clinical Nurse Auditor or Physician Advisor.

  • Utilize proper reference material, standards, and guidelines for coding.

  • Provide input to the Edit Development team on claims selection criteria.

  • Verify data received from client and work to resolve discrepancies.

  • If the contract requires onsite review, interact with Providers and other personnel in a professional manner.

  • Follow policies and processes

  • Comply with department standards regarding productivity and audit quality.

  • Perform other duties as assigned.



To be considered for these challenging roles, applicants must have a majority of the following skills, knowledge and abilities:


  • Possess current AHIMA credentials (RHIT/RHIA/CCS), with current CCS preferred

  • Demonstrate extensive knowledge of ICD-9-CM coding and DRG reimbursement, with a minimum of five years of inpatient coding experience

  • Have an understanding of Medicare, Medicaid, and commercial provider reimbursement methodologies, and possess strong data analysis skills

  • Working knowledge of computer functions and applications such as Microsoft Office (Outlook, Word, Excel) and Windows operating systems

  • Ability to write a well-reasoned review in a narrative style, with accurate spelling, grammar, punctuation, and sentence structure

  • Ability to adapt to changing priorities in order to meet Client requirements and productivity standards and deadlines

  • Ability to travel for additional training and on-site reviews on an as-needed basis

  • Since incumbents will work from their home-based offices, they must have their own access to high-speed Internet connectivity