Remote Medical Records Auditor III

Eightelevengroup; Dayton (OH); Remote; USD 48,000 - 58,000; Full time

Benefits offered by this job

Remote work flexibility

Contract-to-full-time opportunity

Competitive hourly compensation

Professional growth in healthcare

Job summary

Medasource is seeking a Program Integrity Medical Record Reviewer III for a remote, contract-based position with potential for full-time employment. You will perform detailed line-level medical coding reviews of healthcare claims to ensure billed services are supported by medical records and comply with CMS, Medicare, Medicaid, and internal coding guidelines.

The role involves identifying coding discrepancies, overpayments, and payment integrity concerns, collaborating with audit teams,

Qualifications

• Extensive experience in medical coding and billing review.
• Thorough knowledge of CMS, Medicare and State Medicaid coding guidelines.
• Ability to review a broad range of claim types, including professional, E/M, DRG and lab claims.
• Strong attention to detail for identifying coding discrepancies and payment integrity concerns.
• Proven ability to maintain productivity and quality in a high-volume environment.

Responsibilities

• Perform detailed, line-level medical coding reviews of healthcare claims.
• Review medical records and compare documentation against submitted claims for coverage and coding requirements.
• Apply CMS guidelines, State Medicaid requirements, Medicare requirements and internal policies to claim reviews.
• Review a wide range of claim types (professional, E/M, DRG, sepsis, readmissions, labs, specialty).
• Identify coding discrepancies, unsupported services and potential overpayments.
• Maintain productivity with current averages of 4–5 claims per hour and improve with workflow.
• Participate in quality assurance processes and respond to feedback.
• Collaborate with audit and investigation teams to communicate findings.
• Help identify trends warranting provider review or education.
• Ensure compliance with regulatory and organizational requirements.
• Respond promptly to feedback and incorporate QA recommendations.

Job description

Medasource is seeking a Program Integrity Medical Record Reviewer III for a remote, contract-based position with potential for full-time employment. You will perform detailed line-level medical coding reviews of healthcare claims to ensure billed services are supported by medical records and comply with CMS, Medicare, Medicaid, and internal coding guidelines.

The role involves identifying coding discrepancies, overpayments, and payment integrity concerns, collaborating with audit teams,