Certified Medical Coding Reviewer

Job Summary

A company is looking for a Program Integrity Medical Coding Reviewer II.

Key Responsibilities

• Review vendor audit activities and make claim payment decisions based on medical coding guidelines
• Identify and refer suspected Fraud, Waste, or Abuse to the appropriate department
• Support provider pre-pay and post-pay teams with coding reviews and clinical documentation

Required Qualifications

• Associate's degree or equivalent relevant work experience
• Minimum of three (3) years of medical bill coding experience
• Certified Medical Coder (CPC, RHIT, or RHIA) required at time of hire
• Medicaid/Medicare experience preferred
• Clinical background with understanding of claims payment preferred