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Claims Edit Coder Jobs in Virginia (NOW HIRING)

Albanymed

Medical Billing Analyst

Broadway, VA

$46K - $65K/yr

The edits are the result of claims that have previously billed and require an increased ability to ... edit or denial. This may require consistent communication with coding or individual departments.

Albanymed

Medical Billing Analyst

Broadway, VA · On-site

$46K - $65K/yr

The edits are the result of claims that have previously billed and require an increased ability to ... edit or denial. This may require consistent communication with coding or individual departments.

Albanymed

medical billing analyst

Broadway, VA · On-site

$46K - $65K/yr

The edits are the result of claims that have previously billed and require an increased ability to ... edit or denial. This may require consistent communication with coding or individual departments.

Albanymed

medical billing analyst

Broadway, VA · On-site

$46K - $65K/yr

The edits are the result of claims that have previously billed and require an increased ability to ... edit or denial. This may require consistent communication with coding or individual departments.

Albanymed

Medical Billing Analyst

Broadway, VA

$46K - $65K/yr

The edits are the result of claims that have previously billed and require an increased ability to ... edit or denial. This may require consistent communication with coding or individual departments.

Albanymed

Medical Billing Analyst

Broadway, VA

$46K - $65K/yr

The edits are the result of claims that have previously billed and require an increased ability to ... edit or denial. This may require consistent communication with coding or individual departments.

Albanymed

medical billing analyst

Broadway, VA · On-site

$46K - $65K/yr

The edits are the result of claims that have previously billed and require an increased ability to ... edit or denial. This may require consistent communication with coding or individual departments.

Albanymed

Medical Billing Specialist

Broadway, VA

$49K - $69K/yr

Identify and present the payer trends amongst the claims that are denying. Communicate and work ... edit or denial. This may require consistent communication with coding or individual departments.

All JobsClaims Edit Coder JobsClaims Edit Coder Jobs in Virginia

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 Virginia?

For Claims Edit Coder jobs in Virginia, the most frequently searched job titles are:

What job categories do people searching Claims Edit Coder jobs in Virginia look for?

The top searched job categories for Claims Edit Coder jobs in Virginia are:

What cities in Virginia are hiring for Claims Edit Coder jobs?

Cities in Virginia with the most Claims Edit Coder job openings:

Claims Edit Coder jobs near you
Infographic showing various Claims Edit Coder job openings in Virginia as of August 2026, with employment types broken down into 98% Full Time, and 2% Temporary. Highlights an 84% In-person, and 16% Remote job distribution.

Business Analyst - CMdS Claims, Member & Finance Implementation (MES)

Richmond, VA • On-site

Computer Merchant, Ltd., The
See more jobs at Computer Merchant, Ltd., Theexternal

$50 - $60/hr

Other

Medical, Dental, Vision, Life, Retirement

This job post has expired today. Applications are no longer accepted.

Job description

JOB TITLE: Business Analyst - CMdS Claims, Member & Finance Implementation (MES)
JOB LOCATION: Remote
WAGE RANGE*: $50-60/hr
JOB NUMBER: 26-01186
REQUIRED EXPERIENCE:
Required qualifications
  • 12+ years business analysis experience in Medicaid MMIS / MES, with deep hands-on work in at least two of: Claims, Member/Eligibility-Enrollment, Finance/Financial Accounting.
  • Proven experience developing and implementing claims systems / MMIS / MES platforms, such as Conduent CMdS (Conduent Medicaid Suite), Health Enterprise, QNXT, Facets, or comparable commercial Medicaid/claims suites.
  • Experience modernizing or replacing legacy MMIS (COBOL/mainframe or equivalent) with a commercial Medicaid platform.
  • Strong Medicaid domain knowledge, including:
    • FFS vs managed care; capitation vs ASO / administrative services models
    • Claim types, media sources, edits/EOBs, adjustments/voids, Medicare crossover, encounters
    • Aid categories, benefit packages, eligibility spans, timely filing, TPL concepts
    • Provider payments, remittance advice, budget/object codes, COS, fund source / FFP concepts
    • CMS / state Medicaid policy drivers relevant to MES implementation and certification
  • Demonstrated ability to write clear functional design and acceptance criteria for complex adjudication and financial rules.
  • Experience working embedded with development and QA teams in Agile or hybrid SDLC.
  • Excellent facilitation, documentation, and stakeholder communication skills.

Preferred qualifications
  • Hands-on CMdS configuration or implementation (Claims, Member, Finance, Reference, Service Auth).
  • Familiarity with HIPAA X12 (837/835), COBA/crossover, EVV-related claim flows.
  • Experience supporting CMS MES certification artifacts and evidence packages.
  • Prior lead BA experience on multi-module MES releases.

JOB DESCRIPTION
Serve as Business Analyst for CMdS product development and implementation on a Medicaid modernization program. Translate legacy MMIS claims, member, and finance behavior and state Medicaid policy into CMdS functional design, requirements, and acceptance criteria. Partner with development, QA, architecture, and business stakeholders to deliver MES-aligned solutions that replace or integrate with legacy adjudication, eligibility/enrollment, and financial accounting processes.
Key responsibilities
Delivery & analysis
  • Own requirements and functional design for assigned CMdS modules (Claims, Member, Finance, and related interfaces).
  • Define epics, user stories, and definition of done; prioritize against Medicaid policy, MES certification goals, and release plans.
  • Facilitate working sessions; clarify requirements for developers and QA; resolve functional questions during build and test.
  • Track scope, dependencies, risks, and decisions; maintain traceability from legacy rule to CMdS design to test evidence.
Functional design (Claims, Member, Finance)
  • Claims: Lead functional design for claim intake, claim type assignment, validity/pricing edits, adjustment/void, crossover, encounters, remittance, and related edit disposition behavior; map legacy rules to CMdS configuration and customizations.
  • Member: Lead design for eligibility spans, aid category / benefit package assignment, enrollment, MCO/FFS indicators, and interfaces from state eligibility systems into CMdS Member.
  • Finance: Lead design for payment cycles, budget account / category of service, fund splits, ASO / F/EA and other administrative payment paths, financial transactions, and reporting/accounting controls.
  • Produce BRDs, FRDs, process flows, data mapping, gap analysis, and configuration workbooks suitable for build and UAT.
Collaboration with Development & QA
  • Work side-by-side with developers on design walkthroughs, edge cases, and defect triage.
  • Partner with QA to define test scenarios, expected results, and regression packs (positive/negative, adj/void, crossover, encounter, finance posting).
  • Support SIT, UAT, and parallel/run-compare activities against legacy MMIS outcomes.
  • Validate that implementations meet Medicaid policy and MES operational readiness (security, audit, reporting, interfaces).
Stakeholder & MES engagement
  • Run workshops with business owners, SMEs, fiscal, and operations.
  • Align designs to CMS MES expectations (modularity, interoperability, standards-based interfaces, certification evidence).
  • Support change management: training outlines, release notes, and operational runbooks for CMdS go-live.

Equal opportunity employer as to all protected groups, including protected veterans and individuals with disabilities
* While an hourly range is posted for this position, an eventual hourly rate is determined by a comprehensive salary analysis which considers multiple factors including but not limited to: job-related knowledge, skills and qualifications, education and experience as compared to others in the organization doing substantially similar work, if applicable, and market and business considerations. Benefits offered include medical, dental and vision benefits; dependent care flexible spending account; 401(k) plan; voluntary life/short term disability/whole life/term life/accident and critical illness coverage; employee assistance program; sick leave in accordance with regulation. Benefits may be subject to generally applicable eligibility, waiting period, contribution, and other requirements and conditions. Benefits offered are in accordance with applicable federal, state, and local laws and subject to change at TCM's discretion.
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