Medical Coding Auditor & Fraud Review Specialist

W3R Consulting; Illinois; On-site; USD 70,000 - 110,000; Full time

Job summary

W3R Consulting seeks an experienced healthcare auditor to investigate complex claims and verify coding accuracy before payment. You will combine clinical coding expertise with investigative rigor to ensure medical necessity and regulatory compliance across CPT, HCPCS, ICD-10-CM/PCS coding standards.

Please lead pre‑payment reviews, identify fraud or non‑compliance patterns, and prepare audit summaries to inform SIU or Compliance teams as warranted.

Qualifications

• RN license required with active status.
• Certifications in medical coding (CPC/COC/CIC/CPMA or CCS/CCS-P/RHIT/RHIA) mandatory.
• Minimum 5 years in clinical auditing, medical coding, or related healthcare compliance.

Responsibilities

• Triages allegations and investigates third‑party referrals before payment.
• Reviews medical records to verify coding accuracy and medical necessity.
• Audits documentation to ensure CPT, HCPCS, ICD-10-CM/PCS alignment with guidelines.
• Summarizes findings and supports referrals to SIU or Compliance teams when needed.

Skills

Auditing

Claims analysis

Medical coding

Medical record review

Regulatory compliance

Education

RN license

Certified medical coder (CPC/COC/CIC/CPMA or CCS/CCS-P/RHIT/RHIA)

Job description

W3R Consulting seeks an experienced healthcare auditor to investigate complex claims and verify coding accuracy before payment. You will combine clinical coding expertise with investigative rigor to ensure medical necessity and regulatory compliance across CPT, HCPCS, ICD-10-CM/PCS coding standards.

Please lead pre‑payment reviews, identify fraud or non‑compliance patterns, and prepare audit summaries to inform SIU or Compliance teams as warranted.