To support accurate claims processing, the part-time Certified Medical Coding Auditor will remotely review and analyze medical records against submitted claims, ensuring compliance with coding guidelines and identifying potential errors or fraud.
Key responsibilities
Performs clinical reviews of CPT, HCPCS, and modifiers for claims submitted by providers
Determines accuracy of medical coding and provides payment recommendations based on comprehensive evaluations
Identifies aberrant billing patterns and trends, recommending providers for further review as necessary
Required qualifications
Certified Coder AHIMA (CCA, CCS, CCS-P) or AAPC Certified coder (CPC, CPC-I)
2+ years of experience as an AHIMA or AAPC Certified coder
2+ years of CPT/HCPCS/Modifiers coding experience
2+ years of strong medical record review experience
1+ year of experience in the health insurance business, utilizing industry terminology and regulatory guidelines