Claim examiner Jobs in Vallejo, CA

Mercor is working with a leading AI research lab to improve the capabilities of next-generation AI systems. We are seeking experienced Billing and Claims Managers to support the evaluation of AI tools designed to automate and improve medical billing and claims submission workflows. Your expertise in claims processing, payer requirements, EDI transactions, and billing compliance will directly inform AI systems that improve first-pass claim acceptance rates and accelerate revenue cycle performance. **Responsibilities** - Oversee end-to-end medical billing and claims submission operations across professional fee and/or facility billing environments. - Evaluate AI-generated billing outputs, claim edits, and coding validations for accuracy and payer compliance. - Manage claims submission workflows including electronic claim generation, clearinghouse edits, and payer-specific billing requirements. - Monitor clean claim rates, rejection rates, and first-pass acceptance rates and develop improvement strategies. - Coordinate with coding, CDI, and collections teams to resolve billing edits and claim rejections. - Ensure compliance with CMS billing guidelines, HIPAA 837 transaction standards, and payer-specific billing rules. - Manage billing staff workload, productivity, and quality performance metrics. - Develop and maintain billing SOPs and payer-specific billing reference guides. - Annotate AI outputs and provide structured feedback to support AI training datasets. **Requirements** - 5+ years of experience in medical billing and claims management, with at least 2 years in a management role. - Deep knowledge of professional fee (CMS-1500/837P) and/or facility (UB-04/837I) billing requirements. - Expertise in HIPAA 837 transaction standards, clearinghouse operations, and payer-specific billing rules. - Strong understanding of Medicare, Medicaid, and commercial payer billing requirements. - Proficiency with billing platforms (Epic, Athenahealth, AdvancedMD, or equivalent) and clearinghouse tools. - Exceptional written and verbal English communication skills. - High attention to detail with the ability to identify billing errors and compliance issues in AI-generated outputs. **Preferred Qualifications** - CPC, CCS, CHFP, or CRCR certification. - Experience with automated billing platforms and RCM technology implementations. - Background in multi-speciality physician group, hospital, or health system billing operations. - Familiarity with AI tools and comfort evaluating AI-generated billing content. - Experience with payer contract interpretation and billing compliance program management. **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 billing and revenue cycle management. - Opportunity to work on high-impact projects shaping the future of healthcare AI.