REMOTE Healthcare Coding Auditor

Overview At MedReview, our mission is to bring accuracy, accountability, and clinical excellence to healthcare. The Outpatient Payment Integrity Coder Auditor is responsible for reviewing outpatient medical claims to ensure coding accuracy, compliance, and appropriate payment in accordance with CMS and payer-specific guidelines. This role supports the development and implementation of payment integrity initiatives by identifying coding and billing inaccuracies, trends, and potential cost savings opportunities across outpatient facility claims. The ideal candidate has advanced knowledge of outpatient coding, APC and EAPG payment methodologies, and clinical documentation requirements, with strong analytical and auditing skills.
Responsibilities Perform detailed coding audits on outpatient facility claims to validate appropriate CPT/HCPCS, revenue codes, modifiers, and ICD-10 coding in accordance with CMS, NCCI, and payer-specific rules.
Evaluate medical record documentation to ensure services are coded, billed, and reimbursed accurately.
Identify and analyze payment integrity issues including overpayments, underpayments, and incorrect billing patterns.
Collaborate with clinical, data analytics, and payment integrity teams to develop new outpatient claim review concepts and audit strategies.
Provide education and feedback to internal teams or providers based on audit findings.
Research and apply current CMS OPPS, APC, and EAPG guidelines to ensure compliant auditing practices.
Document audit findings clearly and concisely, maintaining a high standard of accuracy and quality assurance.
Contribute to the development and testing of audit tools, rule logic, and automated review concepts to enhance outpatient claim accuracy.
Stay current with regulatory updates, coding changes, and payer policy revisions.
3+ years of experience in outpatient facility coding, auditing, or payment integrity.
Strong knowledge of CMS OPPS, APC, and EAPG payment methodologies.
Proficiency in interpreting medical documentation and applying official coding guidelines.
Preferred Experience with managed care organizations, commercial payer claim reviews, or payment integrity programs.
Familiarity with data analytics tools and claim review platforms.
Prior experience in payment integrity, and audit development strongly preferred.
Experience At least 3 years of experience in Hospital Outpatient Surgery coding.
Expertise with reimbursement methodologies.
Prior experience in payment integrity, and audit development strongly preferred.
Familiarity with data analytics and audit selection processes.
Core Competencies High attention to detail and coding accuracy
Continuous learning and adaptability to regulatory changes
Remote Work Requirements High speed internet (100 Mbps per person recommended) with secured WIFI.
Must be able to sit and use a computer keyboard for extended periods of time.
Benefits Healthcare that fits your needs - We offer excellent medical, dental, and vision plan options that provide coverage to employees and dependents
Generous Paid Time Off - Accrued PTO starting day one, plus additional days off when you’re not feeling well, to observe holidays
Learning & Development - Through continued education/mentorship on the job and our investment in LinkedIn Learning, we’re focused on your growth as a working professional

#