RN Coder

We're hiring RNs to oversee and work the claims data and review possible/flagged claims for over payment. The main part of this job is the clinical decision making where they can either make a determination, ask for more documentation, or elevate to MDs for their review. For example, there are at times heart injuries that are upcoded to heart attacks and the payment is very large and overpaid.

The nurses need to be able to review the clinical work and understand the coding and then be able to make the determination of next steps.

RM will be getting batches of data with flags and comments of where they need the information and delineation from the clinical staff. They are building out an internal system that will mimic those like Cotiviti, etc. and they nurses will be trained on that program.

The cases will be reviews of both inpatient and outpatient but the work will mainly skew inpatient because of the cost of the work. They will be doing both facility and physician billing as well.

We are looking for an RN-Coder Clinical Validation Reviewer to support payment integrity and clinical validation workflows. The ideal candidate is an active RN who also holds a coding credential such as CPC or CCS and has experience reviewing medical records against claims, reimbursement policies, coding rules, or clinical documentation.

You will review professional and/or facility claims against medical records to determine whether the billed service, diagnosis, procedure, code, or payment finding is supported. You will document clear clinical and coding rationale, help identify potential over payments or unsupported claims, and work closely with Akita’s product and operations team to improve AI-supported review workflows.

This role is especially well suited for someone who has worked in payment integrity, clinical documentation review, or coding validation.

• Active RN license in good standing (state requirements TBC).
• Current CPC or CCS certification required; additional coding credentials are a plus.
• Experience reviewing medical records in an inpatient, outpatient, payer, provider, audit, or claims review environment.
• Strong understanding of medical terminology, clinical documentation, and claim coding.
• Ability to determine whether a claim is supported or unsupported based on the medical record.
• Ability to write clear, professional review rationales that could be used in payer, provider, audit, or recovery workflows.
• Strong attention to detail and ability to maintain consistent review standards.
• Comfort working independently in a hybrid environment, including 2-3 days in office required from our Flatiron office in New York, NY.

• Experience in payment integrity, clinical validation, DRG validation, coding validation, CDI, utilization review, claims audit, or over payment review. Familiarity with CPT, HCPCS, ICD-10-CM, ICD-10-PCS, DRG logic, modifiers, CMS/AMA coding rules, CMS coverage policies, or payer reimbursement policies.
• Experience with medical claims platforms, coding tools, EHR/medical record systems, or audit/recovery workflows.
• Experience working with Medicare Advantage, Medicaid, commercial health plans, or managed care organizations.
• Experience reviewing provider disputes, appeals, rebuttals, or audit responses.
• Additional credentials such as CIC, CPMA, COC, RHIT, RHIA, CCDS, or CDIP. ? Comfort giving feedback on new software tools, workflows, or AI-generated review outputs.

Monday-Friday, 40 hours a week between 8am-6pm EST

remote or can sit in Flatiron NY office