Senior Medical Coding Reviewer (TX)

Job Summary

A company is looking for a Senior Medical Coding Reviewer.

Key Responsibilities

• Minimize fraud, waste, and abuse by performing medical claim reviews for compliance with coding guidelines
• Provide coding and clinical decisions on claims, adjustments, and appeals according to coding guidelines and payment policies
• Lead a team of expert witnesses in defending payment decisions during state fair hearings and provider calls

Required Qualifications, Training, and Education

• Associate's Degree in Nursing or a related field required
• 4+ years of medical coding experience required, preferably in provider education and medical record auditing
• LPN or RN state licensure required, or relevant coding certifications (CPC, CCS, RHIT, etc.)
• Experience in a managed care organization preferred
• Medical Record Technician (MRT) certification required