Medical Coding Reviewer

Job Summary

A company is looking for a Medical Coding Reviewer I to perform clinical and coding medical claim reviews.

Key Responsibilities

• Analyze provider billing practices using code auditing software and regulatory guidelines
• Review medical records for consistency with billing for appeals and adjustments
• Identify potential billing errors, fraud, and opportunities for prepayment reviews

Required Qualifications

• Associate's degree in a related field or equivalent experience
• Coding certification and 2+ years of experience in medical billing & coding or related fields
• 2+ years of related clinical experience as an RN or LPN preferred
• Experience in provider communication and education is preferred
• Relevant licenses/certifications such as LPN, RN, CPC, or CCS