Outpatient Payment Integrity Coder - Audit-Driven Revenue

medreview; United States; Remote; USD 58,000 - 65,000; Full time

Job summary

MedReview is seeking an Outpatient Payment Integrity Production Coder in the United States. You will perform claim-level outpatient coding reviews to ensure accuracy, align with CPT/HCPCS, CMS guidance, and payer policies, and identify overpayments.

Strong documentation and independent work ethic are essential. Responsibilities include applying coding hierarchies, supporting auditable findings, and meeting production and quality targets while maintaining compliance with HIPAA and reimbursement

Qualifications

• Current nonexpired coding credential required: CPC, COC, CCS, RHIT, RHIA or equivalent.
• Minimum of 3 years outpatient coding experience required.
• Strong knowledge of CPT, HCPCS, ICD-10-CM, revenue codes, modifier usage, NCCI edits, and payer-specific coding requirements.
• Experience reviewing outpatient facility claims, medical records, operative reports, ED/observation records, and related outpatient services.
• Ability to interpret payer policy, CMS guidance, LCDs/NCDs, coding references, and documentation requirements for claim-level reviews.
• Distinguish between coding validation and payment integrity auditing by evaluating billed vs supported services.
• Strong written communication to document clear audit rationale.
• High attention to detail, analytical thinking, and ability to work independently in a production environment.
• Meet productivity and quality expectations while managing multiple claims and deadlines.
• Proficiency with Outlook, Word, Excel, coding tools, claim review platforms, and EMR systems.

Responsibilities

• Perform outpatient coding reviews using medical records, itemized bills, claim lines, CPT/HCPCS guidance, and NCCI edits.
• Validate that billed outpatient services are supported and correctly coded.
• Identify coding discrepancies, unbundling, and inappropriate modifier usage.
• Apply approved audit target guidance and documentation standards consistently.
• Document audit rationale with references used to support decisions.
• Meet production, quality, turnaround time, and professionalism expectations.
• Escalate complex questions to leads or SMEs as needed.
• Participate in training, calibration reviews, and target refreshers.
• Maintain current knowledge of outpatient coding guidelines and payer policies.

Skills

Outpatient coding

Payer policy interpretation

Audit rationale writing

Attention to detail

Education

CPC, COC, CCS, RHIT, RHIA or equivalent

Tools

3M Encoder tools

TruCode

WebStrat

Microsoft Outlook

Microsoft Word

Microsoft Excel

Job description

MedReview is seeking an Outpatient Payment Integrity Production Coder in the United States. You will perform claim-level outpatient coding reviews to ensure accuracy, align with CPT/HCPCS, CMS guidance, and payer policies, and identify overpayments.

Strong documentation and independent work ethic are essential. Responsibilities include applying coding hierarchies, supporting auditable findings, and meeting production and quality targets while maintaining compliance with HIPAA and reimbursement