Freelance Medical & Billing Coder

Dane Street, LLC; Georgia; Remote; USD 52,000 - 72,000; Full time

Benefits offered by this job

Schedule flexibility

Robust opportunity for supplemental income

User-friendly work portal

Transcription services at no cost

Job summary

A leading medical claims company based in the United States is seeking a Clinical Reviewer to evaluate and ensure the accuracy of medical billing and coding. Ideal candidates will have a CPC, APCC, CMBS, or DRG certification and previous experience in a medical office or healthcare background. This position offers robust supplemental income potential and flexible scheduling to align with your own availability while ensuring high-quality service to clients.

Qualifications

• Must have relevant certification in coding.
• Experience in payment integrity or professional bill review preferred.
• Working knowledge in a medical office or health care setting.
• Healthcare office or care setting background is beneficial.
• Ability to read policy guidelines and healthcare terminology.

Responsibilities

• Evaluate coding appropriateness and client case accuracy.
• Ensure timely reporting and clear communication with clients.
• Provide clinical oversight for complex cases requiring additional reviews.
• Review claims for conflict of interest and criteria fit.
• Work within program timeframes and provide timely QA feedback.
• Offer excellent customer service to clients and teams.
• Provide clinical oversight for complex cases prior to client return.
• Serve as QA support for quality issues and knowledge review.

Skills

Attention to detail

Excellent written and verbal communication

Self-motivated

Proficiency in computer programs

Ability to meet deadlines

Education

CPC, APCC, CMBS, or DRG coder certification

Tools

Google Chrome

Gmail

Google Docs

Google Sheets

Job description

Job Summary

A new program offering on the group health side of our business enables you to apply your clinical knowledge to review reports accompanying medical records to ensure that medical billing information and coding are correct. You will communicate with other reviewers and their office teams to ensure clarity of information and ensure all questions posed have been addressed, and ensure that reports are returned within client deadlines.

Core Duties & Responsibilities

• Evaluates the appropriateness of codes and determine whether they meet all established program standards.
• Ensures that the medical records are matched appropriately to the codes and if not, obtains them.
• Read & apply policy guidelines and healthcare terminology and delineate when criteria are/are not met.
• Evaluates claims for conflict of interest and criteria appropriateness.
• Works within established timeframes set by program parameters.
• Provides strong customer service skills and works closely with clients on a case- by-case basis to provide complete, timely, and error-free quality assurance of cases.
• Provides clinical oversight to cases that are complex and need additional review prior to return to the client.
• Serves as an additional level of QA and clinical knowledge/review for cases with quality Issues.

Required Education & Experience

• Must have a CPC, APCC, CMBS, or DRG coder certification
• Payment integrity or professional bill review experience is strongly preferred.
• Out-of-network bill review experience is a plus.
• Experience working in a remote environment is preferred.
• Experience in a medical office or health care background.

Required Skills

• Must work with a sense of urgency and meet deadlines.
• Must be self-motivated, with a strong drive for performance excellence.
• Excellent written and verbal communication skills are required.
• Proficiency in navigating a variety of computer programs (Experience with Google Chrome, Gmail, Docs, Sheets, etc., is a plus).
• Attention to detail REQUIRED.

PLEASE BE AWARE: In the interest of the security of both parties, please be aware that Dane Street will never conduct an interview via text or request checks from candidates for purchasing equipment.

Benefits

• Robust opportunity for supplemental income
• Schedule flexibility and predictable work hours-conduct reviews based on your schedule availability
• Fully prepped cases, streamlined case flow, transcription services at no cost, and a user-friendly work portal

A fast-paced, Inc. 500 Company with a high-performance culture, Dane Street is seeking insightful, astute 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 Exam and Peer Review programs that assist our clients in reaching the appropriate medical determination as part of the claims management process.