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 implement process improvements and collaborate with internal departments for claim resolutions
• Support provider pre-pay and post-pay teams with coding reviews and prepare claims for Medical Director review

Required Qualifications, Training, and Education

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