Outpatient Payment Integrity Coder & Claims Auditor

DaMar Staffing; 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 audit findings. You will apply CPT/HCPCS guidance, ICD-10-CM guidelines, NCCI edits, and payer policies to maximize client savings.

The role requires current coding certification (CPC/COC/CCS/RHIT/RHIA) and at least 3 years of outpatient coding experience, with strong attention to detail and documentation skills.

Qualifications

• Current nonexpired 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.
• Experience reviewing outpatient facility claims, medical records, and related documentation.
• Ability to interpret payer policies, CMS guidance, LCDs/NCDs, and coding references.

Responsibilities

• Perform outpatient coding reviews using records, CPT/HCPCS guidance, ICD-10-CM guidelines, and billing data.
• Validate that billed outpatient services are properly coded and reported.
• Identify discrepancies, unbundling, improper modifiers, and other audit findings.
• Apply audit guidance, payer policy, and documentation standards consistently.
• Document audit rationale clearly with references and supporting evidence.
• Meet production and quality targets while maintaining accuracy and speed.
• Escalate complex issues to leads or SMEs as needed.
• Participate in training, calibration reviews, and quality feedback sessions.

Skills

CPC

COC

CCS

RHIT

RHIA

CPT

HCPCS

ICD-10-CM

NCCI edits

Modifier usage

Revenue codes

Tools

3M encoder

TruCode

WebStrat

Payer portals

Job description

MedReview is seeking an Outpatient Payment Integrity Production Coder to perform claim-level outpatient coding reviews and ensure accurate, defensible audit findings. You will apply CPT/HCPCS guidance, ICD-10-CM guidelines, NCCI edits, and payer policies to maximize client savings.

The role requires current coding certification (CPC/COC/CCS/RHIT/RHIA) and at least 3 years of outpatient coding experience, with strong attention to detail and documentation skills.