Remote RN Medical Coder | Pre-Payment Auditor (Contract)

Walker Healthforce, Inc.; United States; Remote; USD 85,000 - 105,000; Full time

Benefits offered by this job

Weekly Direct Deposit

Medical, Dental & Vision

401k options

Job summary

Walker Healthforce is seeking a Pre-Payment Clinical Auditor (RN/Medical Coder) with 5 years of combined experience to investigate complex claims and validate coding accuracy. This remote contract role requires expert knowledge of CPT, HCPCS, ICD-10-CM, and CMS guidelines.

Remote nationwide only, excluding NY, CA, HI, and AK, with Monday–Friday 40 hours/week. Start ASAP. We offer weekly pay via Direct Deposit and benefits including medical, dental & vision, and 401k options.

Qualifications

• 5 years of combined experience in clinical auditing, medical coding, payment integrity, or related healthcare reimbursement functions.
• Active RN license.
• National coding certification through AAPC (CPC, COC, CIC, CPMA) or AHIMA (CCS, CCS-P, RHIT, RHIA).
• Proficiency in CPT, HCPCS Level II, ICD-10-CM, and medical record documentation reviews.
• Experience performing medical record reviews, claims audits, and medical necessity assessments.
• Knowledge of CMS reimbursement methodologies, NCCI edits, and applicable federal and state coding regulations.
• Experience identifying fraud, waste, abuse, and healthcare billing irregularities.

Responsibilities

• Investigate complex healthcare claims for potential fraud, waste, abuse, and billing irregularities.
• Review medical records and claims to validate coding accuracy and documentation compliance.
• Conduct pre-payment clinical and technical audits of complex and high dollar claims.
• Evaluate medical necessity and adherence to applicable medical policies.
• Validate coding against CPT, HCPCS, ICD-10-CM, ICD-10-PCS, and Official Coding Guidelines.
• Analyze third party referrals, compliance tips, and external allegations of suspicious billing activity.
• Prepare audit summaries and collaborate with Medical Directors and compliance teams.
• Support referrals to Special Investigations, Provider Performance, and Compliance teams when appropriate.

Skills

RN license

Medical coding

CMS rules

Fraud detection

Documentation review

Tools

CPT

HCPCS

ICD-10-CM

ICD-10-PCS

Job description

Walker Healthforce is seeking a Pre-Payment Clinical Auditor (RN/Medical Coder) with 5 years of combined experience to investigate complex claims and validate coding accuracy. This remote contract role requires expert knowledge of CPT, HCPCS, ICD-10-CM, and CMS guidelines.

Remote nationwide only, excluding NY, CA, HI, and AK, with Monday–Friday 40 hours/week. Start ASAP. We offer weekly pay via Direct Deposit and benefits including medical, dental & vision, and 401k options.