Certified Coder, Auditing

This is a fully remote position, open to applicants in Florida.

📋 Description

• Conduct comprehensive medical coding audits utilizing ICD-10-CM, CPT, and HCPCS.

• Execute utilization reviews to assess medical necessity and ensure documentation compliance.

• Review and compile demand packages along with audit response documentation.

• Analyze records related to payer disputes and recoupment processes.

• Generate written audit findings and defensible reports.

• Offer expert assistance for depositions and testimony as required.

• Evaluate E/M services in accordance with 2021+ guidelines.

• Interpret CMS, LCD/NCD, and specific payer policies.

• Identify areas of risk and compliance vulnerabilities.

• Provide litigation support, including deposition and testimony services when necessary.

• Process and support independent medical examinations and peer review initiatives for insurance claims management.

⛳️ Requirements

• Must be a resident of Florida.

• Possess an active CPC certification from the American Academy of Professional Coders (AAPC).

• Have at least 5 years of professional coding experience.

• A minimum of 3 years of coding experience based in Florida is required.

• Strong understanding of Florida Medicaid (AHCA) billing guidelines, fee schedules, and payer policies.

• Prior experience in auditing and utilization reviews is essential.

• CPMA certification is preferred.

• Experience in supporting legal cases, depositions, or providing expert testimony is highly preferred.

• Excellent skills in written documentation and report generation.

• Ability to work autonomously and adhere to deadlines.

• Strong grasp of medical necessity, documentation compliance, and payer audit defense.

• Proficient coding experience with ICD-10-CM, CPT, and HCPCS.

• Knowledge of 2021+ E/M guidelines.

• Capability to interpret CMS, LCD/NCD, and payer-specific policies.

🏝️ Benefits

• Comprehensive medical, dental, and vision coverage for employees and their families.

• Optional life insurance for employees, their spouses, and children.

• Additional voluntary plans including hospital indemnity, critical illness, accident indemnity, and pet insurance.

• Basic life insurance provided at no cost.

• Short-term disability coverage offered at no cost.

• Long-term disability coverage available at no cost.

• Generous paid time off policy.

• 401(k) plan with employer matching contributions.

• Apple equipment provided for remote workspaces.

• Media stipend available for remote workspaces.