Medical Coding Reviewer I

This is a fully remote position, open to applicants in Arizona, +2 more states.

📋 Description

• Conduct reviews of clinical and coding medical claims to ensure adherence to coding standards.

• Evaluate and analyze medical claims, medical records, claims history, state regulations, contractual commitments, corporate policies and procedures, AMA guidelines, and CMS directives.

• Assess provider billing practices utilizing code auditing software, provider documentation, administrative policies, regulatory codes, legislative mandates, precedent, and AMA/CMS code edit criteria.

• Examine medical records to ensure that billing aligns with medical records for appeals, adjustments, and reviews of miscellaneous/unlisted codes.

• Collaborate with the Medical Director to validate decisions and pinpoint opportunities for developing medical policies where guidelines are lacking.

• Assist in researching health plan coding inquiries.

• Detect potential billing inaccuracies, abuse, and fraudulent activities.

• Recognize potential cases that may require prepayment review.

• Maintain accurate records, files, and documentation.

• Carry out additional duties as assigned.

• Adhere to all relevant policies and standards.

⛳️ Requirements

• Must have authorization to work in the U.S. without the necessity for employment-based visa sponsorship now or in the future.

• Associate’s degree in a related field or equivalent experience is required.

• Coding certification along with a minimum of 2 years of experience in medical billing & coding, coding/data analysis, accounting/business, or physician/hospital data management, or as an RN/LPN with 2+ years of relevant clinical experience.

• Required licenses/certifications include LPN, RN, CPC, CPC-H, CPC-P, CPC-A, CCS, CCS-P, RHIT, RHIA, CPMA, or Paramedic.

• Experience in provider communication and education is preferred.

🏝️ Benefits

• Competitive salary.

• Health insurance coverage.

• 401K and stock purchase plans.

• Tuition reimbursement opportunities.

• Paid time off in addition to holidays.

• Flexible work arrangements including remote, hybrid, field, or office schedules.

• Additional incentives may be included in total compensation.

• Benefits may be subject to program eligibility requirements.