Certified Professional Coder

Job Summary

To ensure compliance with coding practices, the full-time Certified Professional Coder in the Special Investigations Unit will perform medical claim reviews, conduct audits of medical records, and identify billing errors while working remotely.

Key responsibilities

• Conduct comprehensive medical record audits to verify coding accuracy and compliance with documentation
• Provide detailed written summaries of audit findings and articulate these to various stakeholders
• Research and apply state or CMS guidelines related to audits and identify potential billing errors or fraud

Required qualifications

• AAPC Certified Professional Coder Certification (CPC)
• 3+ years of experience in medical coding or documentation auditing
• Knowledge of CPT, HCPCS, ICD-10, and CMS 1500/UB04 data elements
• Experience with researching coding policies
• Proficiency in Microsoft Excel and Word