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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 ...

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 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 ...

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 · On-site

$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 ...

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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 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
Technical Denials Management Specialist III

Technical Denials Management Specialist III

UT Southwestern Medical Center

Dallas, TX • Hybrid

$17.75 - $23.75/hr

Full-time

Posted yesterday

UT Southwestern rating

7.8

Company rating: 7.8 out of 10

Based on 146 frontline employees who took The Breakroom Quiz

104th of 877 rated healthcare providers

Job description

THE UNIVERSITY OF TEXAS SOUTHWESTERN MEDICAL CENTER


 

JOB INFORMATION


 

Job Code: 7006
Job Title: TECHNL DENIALS MGMT SPEC III
Date Last Edited: 8/22/2025
FLSA Status: N


JOB SUMMARY
UT Southwestern Medical Center has an opening within the Revenue Cycle Department team for a Technical Denials Management Specialist III. Responsible for billing applicable payers and ensuring timely collections of various insurance claims; will review, research, and appeal complex denials and inadequate payments from third-party payers while identifying trends of payment problems in an effort to maximize collections. This position is an excellent opportunity for professionals with a background in medical claims, appeals, and payer communications. 
 
Thid ideal candidate will demonstrate expertise in analyzing the following - 
  • Explanation of Benefits (EOBs)
  • Resolving claim denials 
  • Managing appeals 
  • Ensuring time reimbursement 
This is a work-from-home (role); however, the selected candidate must reside in the Greater DFW area and be available for occasional onsite visits for training, equipment pickup, and meetings.   

Shift: 8-hour days, Monday through Friday 

ESSENTIAL FUNCTIONS

Job Duties

  • Contact payers, via website, phone and/or correspondence, regarding reimbursement of unpaid accounts over thirty (30) days or more, also researching and following up on denials and request for additional information.
  • Interpret Manage Care contracts and/or Medicare and Medicaid rules and regulations to ensure proper reimbursement/collection.
  • Make necessary adjustments as required by plan reimbursement.
  • Perform payment validation by utilizing internal and/or external resources to ensure proper reimbursement.
  • Review, research and appeal partially denied claims for reconsideration.
  • Responsible for contacting patients to gain additional information required to resolve outstanding insurance balances.
  • Function as resource person for departmental personnel to answer questions and assist with problem resolution.
  • Review and resolve provider NPI/TPI claim edits rejections.
  • Review and resolve provider NPI/TPI claim denial.
  • Assist with working Claim Edit Work queues.
  • Assist with working Team Lead Work queues.
  • Assist with New Hire Training.
  • Performs other duties as assigned.
 
QUALIFICATIONS
Education and Experience
Required
  • Education
    High School Diploma or
    Associate's Degree
     
  • Experience
    4 years experience in medical claims recovery and/or collections with High School Diploma. or
    2 years experience in medical claims recovery and/or collections within a healthcare or insurance environment is preferred with Associates Degree.
     

Knowledge, Skills and Abilities

  • Work requires a self-starter, with ability to work well as part of a team and independently.
  • Work requires ability to communicate effectively with patients, insurance companies, clinical staff and management.
  • Work requires ability to handle large volumes of work.
  • Work requires ability to work in a fast paced, production-oriented environment.
  • Work requires excellent customer service skills.
  • Work requires experience in Medical Billing, Accounts Receivables, and/or Collections within a healthcare or insurance environment.
  • Work requires good organizational, flexibility and analytical skills when resolving more complex unpaid claims.
  • Work requires knowledge of CMS 1500, ICD-10, and CPT coding is preferred.
  • Work requires one to exhibit excellent work ethics and commitment to job responsibilities. Work requires presence of a positive image that reflects well on the organization.
  • Work requires one to possess a professional and courteous demeanor while being assertive and confident in their collection efforts.
  • Work requires strong written and verbal communication skills.
  • Work requires understanding of the requirements of Medicaid, Medicare and insurance billing.
 
PHYSICAL DEMANDS/WORKING CONDITIONS
  • Physical Demands
    Talking
     
  • Working Conditions
    Office Setting
     
Salary
Salary Negotiable
 
Security
This position is security-sensitive and subject to Texas Education Code 51.215, which authorizes UT Southwestern to obtain criminal history record information.
 
EEO Statement
UT Southwestern Medical Center is committed to an educational and working environment that provides equal opportunity to all members of the University community. As an equal opportunity employer, UT Southwestern prohibits unlawful discrimination, including discrimination on the basis of race, color, religion, national origin, sex, sexual orientation, gender identity, gender expression, age, disability, genetic information, citizenship status, or veteran status.

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