Certified Coder & Auditing (TEXAS BASED ONLY - MUST RESIDE)

About the role

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.

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

Requirements

• 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

Qualifications

• Texas residency is a requirement

Benefits

• Comprehensive benefits package including medical, dental, and vision coverage
• Voluntary life insurance options
• Voluntary benefits such as hospital indemnity, critical illness, accident indemnity, and pet insurance plans
• Bonus of basic life insurance, short-term disability, and long-term disability coverage
• Generous paid time off policy
• Apple equipment and a media stipend for remote workspace

Schedule

This position may be part-time depending on the candidate's qualifications.

Pay

Details on pay are not specified in the job posting.