Remote Medical Coding Specialist (CPC) — QA & Compliance

ExamWorks; Mount Laurel Township (NJ); On-site; USD 50,000 - 70,000; Full time

Job summary

ExamWorks is seeking a Medical Coding Specialist to join our team remotely. The role requires CPC certification with CPMA preferred and involves data input, claim sorting, coding reviews, and quality assurance to ensure HIPAA compliance and accurate invoicing.

Candidates should have at least one year of medical billing experience and the ability to work independently. Schedule is Monday–Friday, 8am–5pm EST, with travel as needed for testimony and provider appeals.

Qualifications

• High school diploma or equivalent required.
• Minimum one year medical billing experience; or equivalent combination of education and experience required.
• Must possess current coding certification in CPC (CPMA certification preferred).
• Must demonstrate understanding of various types of medical billings and ability to identify which system database should be used.
• Must be able to cross reference different types of billings to ensure consistency in the review process.
• Must possess knowledge of standard fee schedule review, UC&R review, drug and supply charges, rarity, utilization review, CPT guidelines, ICD-10, bundling/unbundling, duplicate billing and CMS reimbursement guidelines.
• Must possess complete knowledge of general computer, fax, copier, scanner, and telephone.
• Must be knowledgeable of multiple software programs including Microsoft Word, Outlook, Excel, and the Internet.
• Must have a full understanding of HIPAA regulations and compliance.
• Must be a qualified typist with a minimum of 35 W.P.M.
• Ability to follow instructions and respond to management’s directions accurately.
• Ability to work independently, prioritize work activities and use time efficiently.
• Must maintain confidentiality.
• Must promote a positive team‑oriented environment.
• Must be able to stay focused and concentrate under normal or heavy distractions.
• Must work well under pressure and/or stressful conditions.
• Must manage change, delays, or unexpected events appropriately.
• Follow all company policies and procedures in effect at time of hire and as they may change.

Responsibilities

• Receive and input client and examinee data in the system database.
• Sort and verify each claim.
• Process and review each claim and address all necessary modifications manually. Contact Client as needed.
• Perform quality assurance on every case prior to completion.
• Ensure all medical records and reports are properly documented and saved in the appropriate location and available for audit at all times.
• Process client invoicing in accordance with the client’s fee schedule.
• Handle and respond promptly to incoming calls, emails or faxes from clients requesting report status and/or information.
• Provide notification to the Supervisor of any provider appeals and follow directions as given to resolve the claim.
• Provide testimony in court as to the content of prepared reports, as required. Travel as necessary.
• Ensure all practices are carried out in accordance with HIPAA compliance practices, state and federal safety standards and legal regulations.
• Perform quality assurance on various coding related reviews.
• Perform other duties as assigned.

Skills

CPC certification

CPMA certification

HIPAA compliance

Attention to detail

Independent work

Education

High school diploma or equivalent

Tools

Microsoft Word

Outlook

Excel

Internet

Job description

ExamWorks is seeking a Medical Coding Specialist to join our team remotely. The role requires CPC certification with CPMA preferred and involves data input, claim sorting, coding reviews, and quality assurance to ensure HIPAA compliance and accurate invoicing.

Candidates should have at least one year of medical billing experience and the ability to work independently. Schedule is Monday–Friday, 8am–5pm EST, with travel as needed for testimony and provider appeals.