State Licensed Medical Coding Reviewer

Job Summary

Performing clinical and coding medical claim reviews, the full-time State Licensed Medical Coding Reviewer will ensure compliance with coding practices by analyzing medical claims, records, and regulatory guidelines in a remote work environment.

Key responsibilities

• Analyze provider billing practices using code auditing software and regulatory codes
• Review medical records for consistency with billing for appeals and adjustments
• Collaborate with the Medical Director to validate decisions and develop medical policy

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
• Experience in provider communication and education preferred
• Licensure as LPN, RN, CPC, CPC-H, CPC-P, CPC-A, CCS, CCS-P, RHIT, RHIA, CPMA, or Paramedic