Claims Edit System specialist

Job Title: Claims Edit System specialist -

100% remote

Duration: 3+ Months

Summary: A health plan client of ours is seeking someone with a strong coding background (or CPC certification) to act as a Subject Matter Expert for Claims Edit System (CES) edits. Key tasks include reviewing edits against payment policies, benefit structures, and Medicare/Massachusetts Medicaid requirements, as well as documenting recommendations for leadership approval. This would be a 90-day contract (100% remote) and we’re looking for someone to start in the next 2 weeks (or sooner). Who do you know?

We need someone with Optum CES experience, this is crucial. Please send candidates with strong CES experience. Our client is actively interviewing: Catalyst Solutions

Claims Editing Experience: Please elaborate on your Optum CES experience.

Policy Review Expertise: Have you worked with payment or medical policies, including Medicare or Medicaid (especially Massachusetts Medicaid), to ensure compliance with edits and claims processing?

Coding Certification & Skills: Are you a certified coder (e.g., CPC) with at least 5-7 years of coding experience, and how have you applied this expertise to claims or payment policy reviews?