Immediate need for a talented
Medical Coder/ RN. This is a
06+ Months Contract opportunity with long-term potential and is located in
US (Remote). Please review the job description below and contact me ASAP if you are interested.
Job ID:26-33958
Pay Range: $48.5/hour. Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location).
Key Responsibilities:- Analyze incoming third-party referrals, compliance tips, and external fraud allegations to identify specific billing patterns and suspect providers.
- Identify potential fraud, waste, abuse, and billing irregularities through thorough medical record reviews and claims analysis.
- Perform comprehensive clinical and technical reviews of high-dollar or complex medical records before claims are finalized for payment.
- Audit clinical documentation to ensure strict alignment with CPT, HCPCS, ICD-10-CM, ICD-10-PCS, and Official Coding Guidelines.
- Evaluate medical records against internal medical policies and prepare review summaries as needed.
- Collaborate closely with Medical Directors and prepare audit summaries to support referrals to Special Investigations Unit (SIU) or Compliance teams when warranted.
Key Requirements and Technology Experience:- 5+ years combined experience in clinical auditing, medical coding, payment integrity, SIU investigations, or healthcare compliance.
- Active Nursing RN license.
- Core Coding Credentials: At least one active, nationally recognized coding certification from AAPC (CPC, COC, CIC, CPMA) or AHIMA (CCS, CCS-P, RHIT/RHIA).
- Experience in Behavioral Health coding and auditing.
- Knowledge of DSM-5 documentation requirements.
- Experience auditing mental health, substance use disorder, psychiatric facility, and behavioral health outpatient claims.
Our client is a leading
Healthcare Industry and we are currently interviewing to fill this and other similar contract positions. If you are interested in this position, please apply online for immediate consideration.
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