Compact State Licensed Coding Expert

Job Summary

A company is looking for a Medicare Regulatory and Coding Expert (Remote U.S.)

Key Responsibilities

• Review and interpret CMS medical necessity and prior authorization guidelines
• Maintain the internal Action Code Database (ACD) and monitor CMS regulations
• Assess patient records to determine medical necessity and appropriateness of care

Required Qualifications

• Active and unrestricted LPN/LVN or RN with a Compact State License
• 2+ years of experience as a Certified Medical Coder or Certified Professional Coder
• Graduation from an accredited Nursing Degree Program
• 2+ years of independent clinical experience post-graduation
• 1+ years of experience in Utilization Management or related fields