Certified Professional Coder

Dane Street; Houston, Northern (TX, KY); Hybrid; USD 90,000 - 130,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

Voluntary life insurance

Hospital indemnity

Critical illness

Accident indemnity

Pet insurance

401k with company match

Remote workspace stipend

Apple equipment

Job summary

Dane Street is seeking an experienced CPC-certified medical coder with multi-state experience to perform audits, utilization reviews, and provide litigation support as needed. The role requires reviewing records across multiple states and payer environments.

The ideal candidate has 5–7 years of coding experience, strong CMS regulation knowledge, and prior demand package review or litigation support experience. Remote workspace is available along with a comprehensive benefits package.

Qualifications

• Must hold CPC certification with AAPC
• CPMA strongly preferred
• Minimum 5–7 years of professional coding experience
• Experience auditing across multiple states and payer environments
• Strong knowledge of CMS regulations and state Medicaid variations
• Experience with Medicare, Medicare Advantage, and commercial payer audits
• Prior demand package review or litigation support experience required
• Deposition and/or expert testimony history preferred
• Excellent written reporting and analytical skills
• Ability to work independently and meet strict deadlines
• Part-time capable; review policies and payer rules across jurisdictions

Responsibilities

• Perform comprehensive medical coding audits (ICD-10-CM, CPT, HCPCS)
• Conduct utilization reviews to assess medical necessity and documentation compliance
• Review demand package components for personal injury and insurance cases
• Analyze medical records for payer disputes, recoupments, and appeals
• Prepare detailed, defensible audit reports
• Provide expert review, affidavit support, deposition preparation, and testimony as required
• Interpret CMS guidelines, LCD/NCD policies, and state Medicaid/payer rules
• Review E/M services under 2021+ guidelines
• Identify compliance risks and documentation deficiencies

Skills

CPC certification

CPMA preferred

Multi-state audits

Audits or utilization reviews

CMS regulations knowledge

Medicare/MA/commercial audits

DPR/litigation support

Deposition/testimony experience

Reporting & analysis

Independent work ethic

Part-time capable

Job description

MUST ALREADY HAVE EXPERIENCE DOING BILL AUDIT REVIEWS FOR DIFFERENT STATES.

We are seeking an experienced CPC-certified medical coder with multi-state experience to perform coding audits, utilization reviews, demand package reviews, and provide litigation support including deposition and testimony services as needed. The ideal candidate must have experience reviewing medical records and billing across multiple states and payer environments.

Responsibilities:

• Perform comprehensive medical coding audits (ICD-10-CM, CPT, HCPCS)
• Conduct utilization reviews to assess medical necessity and documentation compliance
• Review the medical portion and prepare the billing and coding review portion of demand package reviews for personal injury and insurance cases
• Analyze medical records for payer disputes, recoupments, and appeals
• Prepare detailed, defensible written audit reports
• Provide expert review, affidavit support, deposition preparation, and testimony when required
• Interpret CMS guidelines, LCD/NCD policies, and state-specific Medicaid and commercial payer rules
• Review E/M services under 2021+ guidelines
• Identify compliance risks and documentation deficiencies

Qualifications:

• Active CPC certification through the American Academy of Professional Coders (AAPC)
• CPMA strongly preferred
• Minimum 5-7 years of professional coding experience
• Documented experience performing audits or utilization reviews in multiple states
• Strong knowledge of CMS regulations and state Medicaid variations
• Experience with Medicare, Medicare Advantage, and commercial payer audits
• Prior demand package review or litigation support experience required
• Deposition and/or expert testimony history preferred
• Excellent written reporting and analytical skills
• Ability to work independently and meet strict deadlines
• This position may be structured as part time Candidates must be comfortable reviewing policies and payer rules across multiple jurisdictions and is able to do multiple types of reviews/audits

Preferred Experience:

• RAC, UPIC, or commercial payer audit response
• Multi-state Medicaid policy interpretation
• Expert witness experience in civil litigation
• Data analysis and audit trend reporting

Join our team at Dane Street and enjoy a comprehensive benefits package designed to support your well-being and peace of mind. We offer a range of benefits including medical, dental, and vision coverage for you and your family. Additionally, we offer voluntary life insurance options for you, your spouse, and your children. We also offer other voluntary benefits which include hospital indemnity, critical illness, accident indemnity, and pet insurance plans. Employees receive basic life insurance, short-term disability, and long-term disability coverage at no cost. Our generous paid time off policy ensures you have time to relax and recharge, while our 401k plan with a company match helps you plan for your future. Apple equipment and a media stipend are provided 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.