Senior Coding Specialist

Overview

Job Location:

US-WI-Madison

We're seeking a skilled coding professional to support accurate, compliant, and high-quality claims processing across Quartz. This role may be filled at the Coding Specialist or Senior Coding Specialist level, depending on experience. You'll play a key role in applying regulatory coding guidance, resolving complex claims and appeals, analyzing billing trends, and collaborating across teams to strengthen payment integrity and reimbursement accuracy.

This position offers hands-on work for experienced coders as well as expanded leadership and subject-matter expertise opportunities for senior-level professionals.

Collaborate with a team that respects and values your coding expertise

• Access professional development opportunities to support your long-term growth

Starting pay range based upon skills and experience: $50,900 to $69,200

+ robust benefits package

• Review and apply regulatory coding guidelines to ensure accurate and compliant claims processing
• Investigate and resolve coding and claims issues, escalating complex matters as appropriate
• Review, edit, and adjudicate pended or denied claims in Health Link (Epic) using Claim Edit Software (CES), regulatory guidance, and internal policies
• Research and resolve coding-related appeals by reviewing medical documentation and collaborating with Medical Directors, Pharmacy, and Medical Management
• Analyze billing and coding data to identify trends, outliers, and potential high-risk billing practices
• Conduct data analysis and reporting to support claim edits, denial trends, and leadership insights
• Respond to coding-related inquiries from providers, members, and internal teams through Service Now and CRM platforms
• Develop and deliver coding education and training for providers, leadership, and internal teams
• Collaborate with cross-functional teams—including Payment Integrity, Medical Management, SIU, Contracting, Benefits, Customer Success, Marketing, and Provider Reimbursement Configuration—to ensure coding compliance
• Stay current on industry trends, regulatory updates, and coding best practices

Additional Responsibilities for Senior-Level Candidates

• Lead the implementation and oversight of regulatory coding guidelines and complex coding initiatives
• Serve as a subject matter expert (SME) for high-risk or complex coding scenarios
• Research, validate, and optimize claim edit logic, business rules, and system configurations; test outcomes and guide improvements
• Partner with the Special Investigation Unit (SIU) to identify, investigate, and address aberrant billing practices and patterns
• Lead or significantly contribute to coding policy, procedure, and claim edit strategy development
• Drive strategy for coding education, provider communication, and internal training initiatives
• Mentor and support mid-level team members and provide guidance on complex coding decisions

• Coding Specialist:
  • High School Equivalency & 1 Year of Relevant Experience
  • Completion of a Medical Coding Program
  • Certifications in CPC, COC, RHIT, RHIA, CCA, and/or CCS
• Senior Coding Specialist:
  • Bachelor's degree with 2 years of relevant experience
  • Or Associate's degree with 5 years of relevant experience
  • Or High School Equivalency with 8 years of relevant experience
  • Completion of a Medical Coding Program
  • Certifications in CPC, COC, RHIT, RHIA, CCA, and/or CCS

Hardware and equipment will be provided by the company, but candidates must have access to high-speed, non-satellite Internet to successfully work from home.

We offer an excellent benefit and compensation package, opportunity for career advancement and a professional culture built on the foundations of Respect, Responsibility, Resourcefulness and Relationships. To support a safe work environment, all employment offers are contingent upon successful completion of a pre-employment criminal background check.

Quartz values and embraces diversity and is proud to be an Equal Employment Opportunity employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sex, gender identity or expression, sexual orientation, age, status as a protected veteran, among other things, or status as a qualified person with disability.