Job Description

Job Description

Terms of Employment

• Contract, 3 Months (Possible Extension)
• Predominantly remote. There will be occasional onsite visits to our client’s office in either: Canton, MD, Washington D.C., Owings Mills, MD or Columbia, MD. Candidates must reside within the Maryland, DC, Virginia or Delaware area.

Overview & Responsibilities

Join our client’s Special Investigations Unit (SIU) as a Medical Coder, leveraging your medical coding expertise to combat fraud, waste, and abuse in healthcare claims. This vital role involves the prepayment review of medical records to ensure accurate billing per industry standards and internal policies. You will be instrumental in clearing a significant backlog of claims and contributing to the integrity of the claims process. This is an excellent opportunity for a certified medical coder seeking a high-impact role with potential for long-term employment.

Key responsibilities include:

• Review medical records and claims for fraudulent indicators and coding accuracy.
• Determine if claims are accurately billed per industry standards (e.g., AMA guidance, AAPC guidance) and internal payment/medical policies.
• Render determinations on claims, which may include denying or paying them based on review findings.
• Utilize coding software (e.g., Codify, Optum Encoder Pro) or CPT manuals to aid in code review and ensure all required components of office visits are met.
• Manage a high volume of claim reviews, contributing to the reduction of a significant backlog.

Required Qualifications:

• High School Diploma or GED.
• Active and validated Certified Professional Coder (CPC) certification or equivalent accreditation (e.g., CPMA, COC, or AHIMA accreditation) without Apprentice tag.
• 3 years of experience in risk adjustment coding, ambulatory coding, and/or CRC coding experience in managed care, state or federal healthcare programs, or the health insurance industry.
• Experience in physician coding, specifically reviewing office visits and services rendered in a physician's office.
• Proficiency in reviewing medical records and claims for coding accuracy.
• Detail oriented.

Preferred Qualifications:

• Experience using coding software such as Codify (AAPC) or Optum Encoder Pro.

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