Certified Medical Coder, Medicare

Job Description: • Perform coding-only medical reviews, with no clinical judgment required, on Medicare Part A/B and DMEPOS claims • Apply ICD-10-CM/PCS, CPT/HCPCS, and DRG/APR-DRG coding rules • Research and apply NCDs, LCDs, and CMS coding/payment guidance • Render and document coding determinations • Identify potential improper payments, coding errors, and documentation patterns indicative of fraud, waste, or abuse for referral consideration • Maintain claim review documentation in the designated case tracking system • Support claim re-review and provider education sessions as requested • Maintain individual accuracy score according to company standards • Complete required annual trainings, including ethics, records management, and security controls • Maintain HIPAA/PHI compliance Requirements: • 3+ years of direct experience in medical coding, medical billing, and/or coding quality assurance/auditing in a healthcare environment • Experience with ICD-10-CM/PCS, CPT/HCPCS, and DRG/APR-DRG coding systems • Active coding certification through AAPC or AHIMA: CPC, CCS, CCS-P, CRC, RHIA, or RHIT • Ability to research, apply, and document coding determinations according to CMS coverage, coding, and payment rules, including NCDs/LCDs • Ability to work independently and productively in a remote, technology-driven, queue-based claims review environment • Working knowledge of HIPAA and other laws/regulations governing confidentiality and privacy of PHI and PII • Working knowledge of CMS system and information security requirements • Associate's degree in a related discipline, or equivalent combination of certification and relevant experience in lieu of a degree • 3+ years of Medicare Fee-for-Service (FFS) claim review experience preferred • Experience with queue-based or low-code/no-code case management systems preferred • Prior experience on a CMS program integrity, audit, or medical review contract preferred Benefits: • Remote position • Reasonable accommodations for individuals with disabilities • Equal employment opportunity