Medical Coder & FWA Audit Specialist

Randstad USA; Boston (MA); On-site; USD 70,000 - 90,000; Full time

Benefits offered by this job

Benefits package including health and

401K plan

Accommodation to accommodate disabled

Job summary

Randstad USA is seeking a Program Integrity Coder- FWA Auditor to verify itemized claim reviews for payment, coding, and billing guidance. The role involves working with SIU Investigators, analyzing medical records, and abstracting codes.

You will maintain current coding knowledge and provide SME support while ensuring Privacy and Security standards are met. Applicants should have 1–2 years of experience in medical record auditing, and hold an active certified coder credential.

Qualifications

• 1-2 years’ experience reviewing and auditing medical records.
• Active Certified coder credential and ability to maintain it.
• Knowledge of anatomy, medical terminology, and billing.
• Ability to interpret ICD-10-CM/PCS, HCPCS/CPT.
• Familiarity with DRG grouping systems and Plan designs.

Responsibilities

• Work with SIU Investigators assisting in research to make coding determinations.
• Analyze and interpret patient records for FWA investigations.
• Compare claim information to determine billable services.
• Determine appropriateness of billing and reimbursement.
• Document findings for each claim line in a spreadsheet.
• Summarize findings in a written report.
• Abstract CPT, HCPCS, Revenue Codes, DRG codes, and ICD-10 from records.
• Maintain knowledge of coding guidelines and regulations.
• Provide SME support to clients and ensure privacy compliance.
• Other duties as needed.

Skills

Anatomy & billing

ICD-10-CM/PCS

HCPCS/CPT

DRG coding

MS-DRG

Communication

Detail oriented

MS Office

EMR systems

Encoders

Education

Certified coder credential (RHIA, RHIT, CPC, CPMA, CIC, COC or CCS-P)

Tools

Encoders

EMR systems

Job description

Randstad USA is seeking a Program Integrity Coder- FWA Auditor to verify itemized claim reviews for payment, coding, and billing guidance. The role involves working with SIU Investigators, analyzing medical records, and abstracting codes.

You will maintain current coding knowledge and provide SME support while ensuring Privacy and Security standards are met. Applicants should have 1–2 years of experience in medical record auditing, and hold an active certified coder credential.