Review E/M services under 2021+ guidelines.
MUST RESIDE IN TEXAS AND HAVE CODING AND AUDITING EXPERIENCE. Counter Affidavit as well as Testimony experience is preferred.
Requirements
We are seeking an experienced CPC certified medical coder to perform coding audits, utilization reviews, audits and more. We are looking for someone who can provide litigation support including deposition and testimony services when needed. The ideal candidate must have strong Texas based coding experience and a thorough understanding of medical necessity, documentation compliance, and payer audit defense. Counter Affidavit experience is preferred.
Responsibilities
Perform detailed medical coding audits (ICD-10-CM, CPT, HCPCS)
Conduct utilization reviews to determine medical necessity and documentation compliance
Review and prepare demand packages and audit response materials
Analyze records for payer disputes and recoupments
Prepare written audit findings and defensible reports
Provide expert support for depositions and testimony as needed
Review E/M services under 2021+ guidelines
Interpret CMS, LCD/NCD, and payer-specific policies
Identify risk areas and compliance vulnerabilities
Required Qualifications
Active CPC certification through the American Academy of Professional Coders (AAPC)
CPMA preferred
Minimum 5 years of professional coding experience
At least 3 years of Texas-based coding experience required
Strong knowledge of Texas Medicaid (TMHP) and Texas commercial payer policies
Prior audit and utilization review experience required
Experience supporting legal cases, depositions, or expert testimony strongly preferred
Excellent written documentation and reporting skills
Ability to work independently and meet deadlines
This position may be part-time depending on the candidate's qualifications. Texas residency is a requirement.
Benefits
Join our team at Dane Street and enjoy a comprehensive benefits package designed to support your well-being and peace of mind. We offer a range of benefits including medical, dental, and vision coverage for you and your family. Additionally, we offer voluntary life insurance options for you, your spouse, and your children. We also offer other voluntary benefits which include hospital indemnity, critical illness, accident indemnity, and pet insurance plans. Employees receive basic life insurance, short-term disability, and long-term disability coverage at no cost. Our generous paid time off policy ensures you have time to relax and recharge, while our 401k plan with a company match helps you plan for your future. Apple equipment and a media stipend are provided for remote workspace.
About Dane Street
A fast-paced, Inc. 500 Company with a high-performance culture, is seeking insightful forward-thinking professionals. We process over 200,000 insurance claims annually for leading national and regional Workers’ Compensation, Disability, Auto, and Group Health Carriers, Third-Party Administrators, Managed Care Organizations, Employers, and Pharmacy Benefit Managers. We provide customized Independent Medical Exams and Peer Review programs that assist our clients in reaching the appropriate medical determination as part of the claims management process.
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