Medical Coder

Job Title: Coding Auditor

Job Summary:
We are looking for a Coding Auditor to review medical records and claims in support of Fraud, Waste & Abuse (FWA) investigations and program integrity initiatives.

Key Responsibilities:

• Review medical records and claims for coding accuracy and potential fraud/waste/abuse.
• Prepare medical review summaries with clear rationale for claim determinations.
• Conduct research related to investigations and medical coding.
• Identify suspicious patterns using coding guidelines, reimbursement methodologies, and healthcare regulations.
• Ensure compliance with federal/state policies and CMS/NCCI guidelines.
• Support special projects and maintain updated knowledge of coding standards.

Requirements:

• 2-5 years of relevant medical coding/auditing experience.
• CPC certification is mandatory.
• Knowledge of ICD, CPT, HCPCS, APC, DRG, Revenue Codes, NDC and CMS/NCCI guidelines.
• Healthcare claims/FWA experience is preferred.
• Strong analytical, research, communication and attention-to-detail skills.
• Good knowledge of MS Office.
• Candidates should be willing to work in different shifts, including night shifts.