Texas Licensed Clinical Consultant

Job Summary

To ensure compliance and accuracy in medical billing, the full-time Texas Licensed Clinical Consultant will conduct audits, provide clinical expertise on claims, and guide coding analysts while working remotely from anywhere within the U.S.

Key responsibilities:

• Investigate and review claims for medical necessity and coding accuracy, making payment recommendations based on findings
• Conduct extensive audits and generate documentation for review, tracking the entire audit process
• Educate healthcare professionals on compliance and documentation improvement to enhance future coding practices

Required qualifications:

• Bachelor's Degree in Nursing and current RN license in good standing
• 4+ years of ICD-9 and ICD-10 coding experience with Medicare claims and medical documentation review
• 4+ years of experience with Medicare policies and regulations
• Solid knowledge of Medicare policies, CMS NCDs, LCDs, and Articles