Certified Medical Coding Reviewer

Job Summary

To support medical record audit activities, the full-time remote Certified Medical Coding Reviewer will review claims for pre-payment and post-payment functions, analyze audit decisions, and collaborate with internal departments to ensure compliance with coding guidelines.

Key responsibilities

• Review medical records to make payment decisions on a variety of claim complexities
• Research and analyze moderately complicated claims based on medical coding guidelines
• Identify and report suspected Fraud, Waste, or Abuse to the appropriate department

Required qualifications

• Certified Medical Coder (CPC, RHIT, or RHIA) required at time of hire
• Associates degree or equivalent relevant work experience
• Three (3) years of medical billing coding experience required
• Medicaid/Medicare experience preferred
• Clinical background with understanding of claims payment preferred