2 jobs found

Craft Health Technologies is seeking an experienced certified medical auditor to provide independent quality review of a sample of our production coding audits. You will compare clinical documentation with the audit’s coding conclusions, determine the correct result, and provide clear, evidence-based feedback. The purpose of the role is to provide external validation, monitor accuracy, and identify opportunities to improve the quality and consistency of our audits. This is a part-time, hourly independent-contractor engagement with flexible scheduling.    Responsibilities   Review a defined sample of completed coding reviews and the corresponding medical records. Independently determine the appropriate CPT, ICD-10-CM, E/M level, and modifiers, as applicable. Assess whether coding conclusions are supported by the clinical documentation and current guidelines. Identify overcoding, undercoding, unsupported conclusions, missed documentation,...

Overview Exponent is hiring medical billers, coders, prior-authorization and insurance-verification specialists, and pharmacy technicians as subject matter experts for a healthcare technology client. You will evaluate revenue-cycle and authorization workflows in a simulated environment and document where the environment differs from real-world practice. This is a remote, part-time, contract engagement. No protected health information is involved. Responsibilities Complete assigned workflows in a simulated environment: eligibility and benefits verification, authorization submission and appeals, claim generation and scrubbing, remittance review, charge entry, coding and abstracting, and fax routing Identify steps that fail, behave differently from the production system, or are missing Document findings in structured forms and short written notes Attend a remote onboarding session and periodic check-ins Qualifications 5+ years in revenue cycle, coding, prior...