Outpatient Coding Auditor for Payment Integrity

MedReview; New York (NY); On-site; USD 58,000 - 65,000; Full time

Job summary

MedReview is seeking an Outpatient Payment Integrity Production Coder to perform claim-level outpatient coding reviews and ensure accurate, defensible findings that support client savings.

The role requires CPT/HCPCS/ICD-10-CM expertise, adherence to payer policies, and strong written audit rationale. You will apply CMS guidance, NCCI edits, LCDs/NCDs, and documentation standards while meeting production targets in a fast-paced environment.

Qualifications

• Current nonexpired outpatient coding certification (CPC/COC/CCS/RHIT/RHIA or equivalent).
• Minimum 3 years of outpatient coding experience.
• Strong knowledge of CPT, HCPCS, ICD-10-CM, revenue codes, modifiers, and NCCI edits.
• Ability to interpret payer policy, CMS guidance, LCDs/NCDs, and documentation requirements.

Responsibilities

• Perform outpatient coding reviews using medical records, bills, CPT/HCPCS guidance, ICD-10-CM guidelines, and NCCI edits.
• Validate that billed outpatient services are supported and codes/units/revenue codes are correct.
• Identify coding discrepancies, unbundling, improper modifiers, and documentation gaps.
• Document audit rationale clearly with references and supporting evidence.
• Maintain productivity and quality within turnaround times.

Skills

Attention to detail

Analytical thinking

Independent work

Strong written communication

Time management

Education

CPC, COC, CCS, RHIT, RHIA or equivalent

Tools

Microsoft Outlook

Microsoft Word

Microsoft Excel

Coding tools

EMR systems

3M Encoder

TruCode

WebStrat

Job description

MedReview is seeking an Outpatient Payment Integrity Production Coder to perform claim-level outpatient coding reviews and ensure accurate, defensible findings that support client savings.

The role requires CPT/HCPCS/ICD-10-CM expertise, adherence to payer policies, and strong written audit rationale. You will apply CMS guidance, NCCI edits, LCDs/NCDs, and documentation standards while meeting production targets in a fast-paced environment.