CPC Certified Medical Coding Reviewer

Job Summary

To enhance team performance, the full-time remote CPC Certified Medical Coding Reviewer III will generate detailed reports, recommend process improvements, and mentor claims analysts while ensuring compliance with medical coding guidelines and regulations.

Key responsibilities:

• Provide production and progress reports for Provider Pre Pay and coordinate recommendations for performance improvement
• Mentor Program Integrity Claims Analysts and identify training opportunities to address knowledge gaps in coding and documentation
• Analyze complex provider claims submissions using CPT, ICD10, HCPCS, and DRG coding rules, while ensuring adherence to state and federal guidelines

Required qualifications:

• Associate's degree or equivalent relevant work experience is required
• Minimum of five years of medical billing and coding experience, including three years in SIU/FWA medical billing and coding
• Prior experience with claim pre-payment and medical claim auditing is required
• Medicaid/Medicare experience is required
• Certified Medical Coder (CPC, RHIT, or RHIA) is required at time of hire