State Licensed Senior Medical Coder

Job Summary

A company is looking for a Senior Medical Coding Reviewer.

Key Responsibilities

• Minimize fraud, waste, and abuse by performing medical claim reviews for compliance with coding guidelines
• Provide coding/clinical decisions on claims, adjustments, and appeals according to coding guidelines and payment policies
• Lead a team in defending payment decisions during state fair hearings and maintain review guidelines for medical coding

Required Qualifications

• Associate's Degree in Nursing or a related field required
• 4+ years of Medical Coding Experience required
• Licensure as LPN or RN, or certifications such as CPC, CCS, RHIT, RHIA, or CPMA required
• Experience in provider education and medical record auditing preferred
• Experience in a managed care organization preferred