About the job
We are looking for a skilled and CPC-certified medical coder with extensive experience in conducting bill audit reviews across various states. The ideal candidate will excel in performing coding audits, utilization reviews, demand package evaluations, and providing litigation support, including deposition and testimony services as required.
Your responsibilities will include:
- Executing thorough medical coding audits (ICD-10-CM, CPT, HCPCS)
- Conducting utilization reviews to ensure medical necessity and compliance with documentation
- Preparing demand packages for personal injury and insurance cases
- Analyzing medical records for payer disputes, recoupments, and appeals
- Drafting comprehensive and defensible written audit reports
- Providing expert review, affidavit support, deposition preparation, and testimony as necessary
- Interpreting CMS guidelines, LCD/NCD policies, and state-specific Medicaid and commercial payer regulations
- Reviewing E/M services under 2021+ guidelines
- Identifying compliance risks and documentation deficiencies

