Certified Professional Coder – Special Investigations Unit

Jobtailor; Alabama; On-site; USD 65,000 - 90,000; Full time

Job summary

Jobtailor is seeking an experienced Medical Coding Auditor to conduct comprehensive medical record reviews and ensure billing accuracy. You will craft detailed written summaries and present findings to investigators, leadership, counsel, providers, and regulators.

Role requires reviewing cases with Medical Directors, researching coding policies, and potentially testifying. Travel for meetings is expected, and strong Excel skills are essential.

Qualifications

• AAPC Coding certification is required (CPC).
• 3+ years of experience in medical coding or documentation auditing.
• Strong knowledge of CPT, HCPCS, Revenue Codes, CMS 1500 and UB04 data elements.
• Experience researching coding, state regulations and policies.
• Proficiency with Microsoft Excel.

Responsibilities

• Conduct comprehensive medical record reviews to ensure billing aligns with medical records.
• Provide detailed written summaries of medical record review findings.
• Articulate findings to investigators, Medicaid plan leadership, law enforcement, legal counsel, providers and state regulators.
• Review and discuss cases with Medical Directors to validate decisions.
• Assist with investigative research related to coding questions, state and federal policies.
• Identify potential billing errors, abuse and fraud.
• Identify opportunities for savings related to potential prepayment review cases.
• Maintain appropriate records, files and documentation.
• Travel for meetings and potentially testify.

Skills

Medical Record Review

Billing Consistency Analysis

Documentation Auditing

Investigative Research

Communication Skills

Detail Orientation

Analytical Thinking

Education

GED or equivalent

Certified Professional Coder (CPC)

Tools

Microsoft Excel

Job description

• Conduct comprehensive medical record reviews to ensure billing is consistent with medical records
• Provide detailed written summaries of medical record review findings
• Articulate findings to investigators, Medicaid plan leadership, law enforcement, legal counsel, providers and state regulators
• Review and discuss cases with Medical Directors to validate decisions
• Assist with investigative research related to coding questions, state and federal policies
• Identify potential billing errors, abuse and fraud
• Identify opportunities for savings related to potential prepayment review cases
• Maintain appropriate records, files and documentation
• Travel for meetings and potentially testify

Requirements

• AAPC Coding certification — Certified Professional Coder (CPC)
• 3+ years of experience in medical coding or documentation auditing
• Strong knowledge of CPT, HCPCS, Revenue Codes, CMS 1500 and UB04 data elements
• Experience researching coding, state regulations and policies
• Working experience with Microsoft Excel
• Ability to travel for meetings and potential to testify
• GED or equivalent
• AAPC Certified Professional Coder Certification (CPC)

Core Competencies

Demonstrates expertise in medical coding and documentation auditing, with a strong focus on compliance with state and federal regulations. Proficient in conducting medical record reviews and articulating findings to various stakeholders.

Highest-signal resume keywords

• AAPC Coding Certification
• Medical Coding Experience
• Knowledge of CPT and HCPCS
• Microsoft Excel Proficiency
• Investigative Research Skills

Hard Skills

• Medical Record Review
• Billing Consistency Analysis
• Coding Research
• Billing Error Identification
• Documentation Auditing

Soft Skills

• Communication Skills
• Detail Orientation
• Analytical Thinking

Certifications & Qualifications

• Certified Professional Coder (CPC)

Industry Keywords

• CPT Codes
• HCPCS Codes
• Revenue Codes
• CMS 1500
• UB04 Data Elements
• State Regulations
• Federal Policies