Claim examiner Jobs in Palmdale, CA

Mercor is working with a leading AI research lab to improve the capabilities of next-generation AI systems. We are seeking experienced Coding Managers and HIM Coding leaders to evaluate AI-powered coding solutions and help train next-generation autonomous coding systems. Your expertise in professional fee (profee) and/or inpatient facility coding, ICD-10-CM/PCS, CPT/HCPCS, and HIM operations will directly inform AI tools designed to improve coding accuracy, productivity, and compliance across healthcare settings. **Responsibilities** - Oversee professional fee and/or facility inpatient coding operations, ensuring accuracy, productivity, and compliance with coding guidelines. - Evaluate AI-generated coding assignments, including ICD-10-CM/PCS diagnoses, procedure codes, CPT/HCPCS codes, and DRG assignments, for accuracy and compliance. - Conduct coding quality audits and provide targeted feedback to coding staff and AI systems. - Monitor coding KPIs including coder productivity, accuracy rates, unbilled accounts, and claim denial rates attributable to coding errors. - Manage coding workflow queues, work distribution, and turnaround time compliance. - Ensure adherence to Official Coding Guidelines, CMS regulations, and payer-specific coding requirements. - Provide ongoing coding education and compliance training to coding staff. - Collaborate with CDI, billing, and compliance teams to address coding-related revenue integrity issues. - Annotate AI-generated coding outputs and provide structured feedback to support AI training datasets. **Requirements** - 5+ years of experience in medical coding, with at least 2 years in a coding manager or HIM leadership role. - Expert knowledge of ICD-10-CM/PCS, CPT/HCPCS, and Official Coding Guidelines. - Proficiency in professional fee (profee) coding and/or facility inpatient coding with DRG assignment experience. - Experience conducting coding audits and developing coding quality improvement programs. - Proficiency with coding software (3M, Nuance, Optum360, TruCode) and EHR platforms. - Exceptional written and verbal English communication skills. - High attention to detail with the ability to identify coding errors, compliance risks, and AI output inaccuracies. **Preferred Qualifications** - CPC (Certified Professional Coder), CCS (Certified Coding Specialist), RHIA, or RHIT credential. - Experience with computer-assisted coding (CAC) tools and NLP-based coding platforms. - Background in inpatient facility coding with DRG optimisation experience. - Familiarity with AI coding tools and comfort evaluating AI-generated coding assignments. - Experience presenting coding performance data and quality metrics to leadership. **Why Join?** - Contribute to the development of frontier AI systems in healthcare. - Collaborate with a world-class AI research organisation. - Gain exposure to cutting-edge AI workflows in medical coding and health information management. - Opportunity to work on high-impact projects shaping the future of healthcare AI.