Conduct retrospective medical claims reviews for coding accuracy, pricing, and DRG validation for inpatient and outpatient services. Act as a subject matter expert on medical coding, support internal teams, and prepare determination documentation.
Review and validate medical claims using ICD-10-CM, ICD-10-PCS, CPT, and HCPCS codes.
Perform DRG validation and coding audits for inpatient/outpatient claims.
Identify coding errors, quality issues, and potential fraud.
Provide guidance and training to coding staff.
Prepare determination letters and maintain accurate documentation.
Support claims review processes and ensure timely completion.
High School Diploma or GED required.
Certification: CIC, CCS, or RHIT required.
U.S. Citizen with ability to pass DoD background check.
5+ years of clinical coding experience.
3+ years of claims processing experience.
Preferred: Experience in healthcare, insurance, or managed care.
Preferred: Familiarity with military healthcare systems.
Strong knowledge of coding systems and DRG validation.
Analytical and problem-solving skills.
Detail-oriented and well-organized.
Effective communication and teamwork skills.
Proficient in MS Word and Excel.
Remote role with flexible shift availability.
Ability to work independently with prolonged computer use.
- High School Diploma or GED
- Certification: CIC, CCS, or RHIT
- U.S. Citizen with ability to pass DoD background check
- 5+ years of clinical coding experience
- 3+ years of claims processing experience
- Preferred: Experience in healthcare, insurance, or managed care
- Preferred: Familiarity with military healthcare systems
- Strong knowledge of ICD-10-CM, ICD-10-PCS, CPT, HCPCS codes and DRG validation
- Analytical and problem-solving skills
- Detail-oriented with strong organizational ability
- Effective communication and teamwork skills
- Proficient in MS Word and Excel
Location
N/A
Employment Type
Temporary
Experience Level
Senior
Remote work allowed
Yes
Posted
3 weeks ago