Medical Coding Auditor

About Our Client:The organization operates globally in the healthcare sector, focusing on improving health outcomes by connecting individuals with healthcare services, pharmacy benefits, and relevant data. It addresses challenges in healthcare access and optimization by leveraging technology and comprehensive resources to support healthier lives. About the Opportunity:The MEDICAL CODING AUDITOR is responsible for ensuring the accuracy of medical claims submitted by providers by comparing claims against medical records. This role supports the identification of suspected waste and error in health insurance claims and ensures compliance with state and federal guidelines. The position significantly impacts the organization by safeguarding proper payment practices and maintaining regulatory adherence. Responsibilities:Review clinical codes (CPT, HCPCS, modifiers) on claims remotelyAssess accuracy of coding and billing for claimsConsult medical directors or physicians as neededInterpret state and federal mandates, benefit language, and policiesDetermine appropriate service levels using Evaluation and Management coding principlesDocument case outcomes with detailed clinical narrativesEnsure compliance with reimbursement and contract policiesDetect aberrant billing patterns and potential fraud or wasteManage daily case assignments meeting quality and productivity standardsProvide clinical expertise to investigative and analytical teamsParticipate in team meetings and collaborate as neededServe as a clinical resource within the investigative teamCoordinate with business partners for additional clinical information Requirements:Certified Coder from AHIMA (CCA, CCS, CCS-P) or AAPC (CPC, CPC-I)Minimum of 2 years coding experience with CPT/HCPCS/ModifiersAt least 2 years reviewing medical recordsExperience working in team settings with metric-driven production and quality standards Pay Range and Compensation Package:Hourly pay ranges from $24.00 to $43.00 based on experience and full-time employmentAdditional benefits include a comprehensive benefits package, incentive programs, equity stock purchase, and 401(k) contributions Benefits & Perks:401(k) retirement plan Equal Opportunity Statement: Our client is an equal opportunity employer. They celebrate diversity and are committed to creating an inclusive environment for all employees. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, or national origin. Note:RemoteHunter is a recruitment partner of this role. Please note that all employment decisions, including candidate assessment, interviews, hiring, compensation, and employment terms, are made exclusively by the hiring employer.