Medicare Compliance & Coding Expert Associate

Acentra Health, LLC; United States; On-site; USD 40,000 - 51,000; Full time

Job summary

Acentra Health is seeking a Medicare Regulatory and Coding Expert Associate to join our team. This role uses expertise in medical coding and Medicare guidelines to maintain an internal reference tool (ACD) and ensure CMS compliance.

The position supports utilization management, applies medical necessity criteria, and collaborates with clients and claims administrators to maintain production standards and HIPAA compliance.

Qualifications

• Active, unrestricted RN license in a compact state.
• Certified Medical Coder credential.
• Nursing degree from an accredited program.
• 2+ years of clinical experience post-graduation.
• 1+ year UM/Prior Authorization or related experience.
• Experience with Part B Medicare.
• Advanced Microsoft Excel skills.
• CMS regulatory requirements, compliance, and quality knowledge.

Responsibilities

• Interpret CMS medical necessity and prior authorization guidelines.
• Maintain knowledge of CMS regulations, transmittals and guidance.
• Manage ACD spreadsheet and database in Microsoft Access.
• Schedule and host ACD meetings with client teams.
• Review CPT reports and provide data-driven suggestions with Manager review.
• Maintain codes in ACD and update with client input.
• Assess records against criteria to determine medical necessity.
• Approve or refer decisions; document denial reasons clearly.

Skills

RN license

Certified Medical Coder

Microsoft Excel

CMS regulations knowledge

Medical records review

Communication skills

Team collaboration

Microsoft Office

Education

Registered Nursing Degree

Tools

Microsoft Access

Job description

Acentra Health is seeking a Medicare Regulatory and Coding Expert Associate to join our team. This role uses expertise in medical coding and Medicare guidelines to maintain an internal reference tool (ACD) and ensure CMS compliance.

The position supports utilization management, applies medical necessity criteria, and collaborates with clients and claims administrators to maintain production standards and HIPAA compliance.