Certified Medical Coding Reviewer

Job Summary

To support medical record audit activities, the full-time Certified Medical Coding Reviewer will review claims for pre-payment and post-payment functions, research and analyze claims, and collaborate with internal departments, all while working remotely.

Key responsibilities:

• Make payment decisions on a variety of claims based on medical coding guidelines and policies
• Research and analyze moderately complicated claims, ensuring adherence to departmental standards
• Identify and report suspected Fraud, Waste, or Abuse, and implement process improvements

Required qualifications:

• Associate's degree required; equivalent work experience may be accepted in lieu of education
• Three years of medical billing coding experience required
• Certified Medical Coder (CPC, RHIT, or RHIA) required at time of hire
• Medicaid/Medicare experience preferred
• Clinical background with understanding of claims payment preferred