Certified Medical Coder, Medicare

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

📋 Description

• Conduct coding-only medical evaluations, requiring no clinical judgment, on Medicare Part A/B and DMEPOS claims.

• Implement ICD-10-CM/PCS, CPT/HCPCS, and DRG/APR-DRG coding regulations.

• Investigate and apply NCDs, LCDs, and CMS coding/payment guidelines.

• Make and document coding decisions.

• Detect potential improper payments, coding inaccuracies, and documentation trends that may suggest fraud, waste, or abuse for further referral.

• Keep claim review records in the specified case tracking system.

• Assist with claim re-reviews and provider education sessions when needed.

• Maintain individual accuracy ratings in accordance with company standards.

• Fulfill mandatory annual training requirements, including ethics, records management, and security protocols.

• Ensure compliance with HIPAA/PHI regulations.

⛳️ Requirements

• Over 3 years of hands-on experience in medical coding, medical billing, and/or coding quality assurance/auditing within a healthcare setting.

• Proficient in ICD-10-CM/PCS, CPT/HCPCS, and DRG/APR-DRG coding systems.

• Possession of an active coding certification from AAPC or AHIMA: CPC, CCS, CCS-P, CRC, RHIA, or RHIT.

• Capability to research, apply, and document coding determinations per CMS coverage, coding, and payment standards, including NCDs/LCDs.

• Ability to work autonomously and efficiently in a remote, technology-oriented, queue-based claims review setting.

• Familiarity with HIPAA and other regulations governing the confidentiality and privacy of PHI and PII.

• Understanding of CMS systems and information security requirements.

• Associate's degree in a relevant field, or a combination of certification and pertinent experience in place of a degree.

• Preference for candidates with over 3 years of Medicare Fee-for-Service (FFS) claim review experience.

• Preferred experience with queue-based or low-code/no-code case management systems.

• Previous experience with a CMS program integrity, audit, or medical review contract is preferred.

🏝️ Benefits

• Remote position.

• Reasonable accommodations available for individuals with disabilities.

• Equal employment opportunity.