Certified Coder & Auditing (FLORIDA-BASED ONLY - MUST RESIDE)

Dane Street, LLC; Town of Florida (NY); Sur place; USD 65 000 - 90 000; Temps partiel

Avantages offerts par ce poste

Medical, dental, and vision coverage

401k plan with company match

Apple equipment and remote workspace"

Paid time off

Disability coverage

Voluntary life insurance

Hospital indemnity and critical Ill/AD

Résumé du poste

Dane Street is seeking an experienced CPC-certified medical coder to perform coding audits, utilization reviews, and related tasks with Florida-based expertise. The role may include litigation support such as depositions and testimony when needed, and requires strong knowledge of Florida Medicaid guidelines and payer policies.

Ideal candidates have 5+ years of coding and audit experience, including Florida-based work, and excel at documenting findings with defensible reports.

Qualifications

• Active CPC certification through AAPC.
• CPMA preferred.
• Minimum 5 years of professional coding experience.
• At least 3 years of Florida-based coding experience.
• Strong knowledge of Florida Medicaid billing guidelines and payer policies.
• Prior audit and utilization review experience.
• Experience supporting legal cases, depositions, or expert testimony.

Responsabilités

• Perform detailed medical coding audits (ICD-10-CM, CPT, HCPCS).
• Conduct utilization reviews to determine medical necessity and documentation compliance.
• Review and prepare demand packages and audit response materials.
• Analyze records for payer disputes and recoupments.
• Prepare written audit findings and defensible reports.
• Provide expert support for depositions and testimony as needed.
• Review E/M services under 2021+ guidelines.
• Interpret CMS, LCD/NCD, and payer-specific policies.
• Identify risk areas and compliance vulnerabilities.

Connaissances

CPC certification

CPMA preferred

5+ years coding experience

Florida-based coding experience

Audits & utilization reviews

Litigation support (depositions/testy)

Description du poste

MUST RESIDE IN FLORIDA AND HAVE CODING AND AUDITING EXPERIENCE. Deposition as well as Testimony experience is preferred.

We are seeking an experienced CPC certified medical coder to perform coding audits, utilization reviews, audits and more. We are looking for someone who can provide litigation support including deposition and testimony services when needed. The ideal candidate must have strong Florida-based coding experience and a thorough understanding of medical necessity, documentation compliance, and payer audit defense.

Join our team at Dane Street and enjoy a comprehensive benefits package designed to support your well-being and peace of mind.

Responsibilities:

• Perform detailed medical coding audits (ICD-10-CM, CPT, HCPCS)
• Conduct utilization reviews to determine medical necessity and documentation compliance
• Review and prepare demand packages and audit response materials
• Analyze records for payer disputes and recoupments
• Prepare written audit findings and defensible reports
• Provide expert support for depositions and testimony as needed
• Review E/M services under 2021+ guidelines
• Interpret CMS, LCD/NCD, and payer-specific policies
• Identify risk areas and compliance vulnerabilities

Required Qualifications:

• Active CPC certification through the American Academy of Professional Coders (AAPC)
• CPMA preferred
• Minimum 5 years of professional coding experience
• At least 3 years of Florida-based coding experience required
• Strong knowledge of Florida Medicaid (AHCA) billing guidelines, fee schedules, and Florida payer policies.
• Prior audit and utilization review experience required
• Experience supporting legal cases, depositions, or expert testimony strongly preferredExcellent written documentation and reporting skills
• Ability to work independently and meet deadlines

This position may be part-time depending on the candidate's qualifications. Florida residency is a requirement.

Benefits:

• medical, dental, and vision coverage for you and your family
• voluntary life insurance options for you, your spouse, and your children
• hospital indemnity, critical illness, accident indemnity, and pet insurance plans
• basic life insurance, short-term disability, and long-term disability coverage at no cost
• paid time off policy
• 401k plan with a company match
• Apple equipment and a media stipend for remote workspace

About Dane Street:

A fast-paced, Inc. 500 Company with a high-performance culture, is seeking insightful forward-thinking professionals. We process over 200,000 insurance claims annually for leading national and regional Workers’ Compensation, Disability, Auto, and Group Health Carriers, Third-Party Administrators, Managed Care Organizations, Employers, and Pharmacy Benefit Managers. We provide customized Independent Medical Exams and Peer Review programs that assist our clients in reaching the appropriate medical determination as part of the claims management process.