Certified Medical Coding Auditor

Job Summary

To support accurate claims processing, the part-time Certified Medical Coding Auditor will remotely review and analyze medical records against submitted claims, ensuring compliance with coding guidelines and identifying potential errors or fraud.

Key responsibilities

• Performs clinical reviews of CPT, HCPCS, and modifiers for claims submitted by providers
• Determines accuracy of medical coding and provides payment recommendations based on comprehensive evaluations
• Identifies aberrant billing patterns and trends, recommending providers for further review as necessary

Required qualifications

• Certified Coder AHIMA (CCA, CCS, CCS-P) or AAPC Certified coder (CPC, CPC-I)
• 2+ years of experience as an AHIMA or AAPC Certified coder
• 2+ years of CPT/HCPCS/Modifiers coding experience
• 2+ years of strong medical record review experience
• 1+ year of experience in the health insurance business, utilizing industry terminology and regulatory guidelines