Licensed Clinical Coding Investigator

Job Summary

To ensure compliance and accuracy in medical coding, the part-time Licensed Clinical Coding Investigator will perform quality audits, analyze claims against medical records, and provide coding expertise while working remotely.

Key responsibilities:

• Conducts quality audits of clinical review cases for CPT, HCPCS, and modifiers in a telecommuting environment
• Determines the accuracy of medical coding and payment recommendations for pre-payment claims
• Identifies aberrant billing patterns and trends, recommending providers for review as necessary

Required qualifications:

• High School Diploma/GED
• Certified Coder (AHIMA or AAPC) or active Nurse license with medical record auditing experience
• 2+ years of experience in coding (CPT/HCPCS/ICD) or as a licensed nurse with coding experience
• 2+ years of experience with health insurance terminology and regulatory guidelines
• Intermediate computer skills, including proficiency with Microsoft and Adobe applications