CPC Certified Medical Coding Reviewer

Job Summary

Supporting complex medical record audit programs, the full-time remote CPC Certified Medical Coding Reviewer III will manage provider pre-pay production reports, recommend process improvements, and mentor audit analysts while ensuring compliance with medical coding guidelines.

Key responsibilities

• Provide production and progress reports for provider pre-pay audits and coordinate with management for performance enhancements
• Recommend process changes and build relationships with cross-departmental teams to address internal system gaps
• Mentor Program Integrity Audit Analysts and identify training opportunities to enhance coding and documentation recognition

Required qualifications

• Associates degree required, or equivalent relevant work experience accepted
• 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 required
• Medicaid/Medicare experience required
• Certified Medical Coder (CPC, RHIT, or RHIA) required at time of hire