Coder, Bill Audit Reviews

Job Description:

• Perform comprehensive medical coding audits (ICD-10-CM, CPT, HCPCS)
• Conduct utilization reviews to assess medical necessity and documentation compliance
• Review and prepare demand packages for personal injury and insurance cases
• Analyze medical records for payer disputes, recoupments, and appeals
• Prepare detailed, defensible written audit reports
• Provide expert review, affidavit support, deposition preparation, and testimony when required
• Interpret CMS guidelines, LCD/NCD policies, and state-specific Medicaid and commercial payer rules
• Review E/M services under 2021+ guidelines
• Identify compliance risks and documentation deficiencies

Requirements:

• Active CPC certification through the American Academy of Professional Coders (AAPC)
• CPMA strongly preferred
• Minimum 5–7 years of professional coding experience
• Documented experience performing audits or utilization reviews in multiple states
• Strong knowledge of CMS regulations and state Medicaid variations
• Experience with Medicare, Medicare Advantage, and commercial payer audits
• Prior demand package review or litigation support experience required
• Deposition and/or expert testimony history preferred
• Excellent written reporting and analytical skills
• Ability to work independently and meet strict deadlines.

Benefits:

• Join our team at Dane Street and enjoy a comprehensive benefits package designed to support your well-being and peace of mind.
• We offer a range of benefits including medical, dental, and vision coverage for you and your family.
• Additionally, we offer voluntary life insurance options for you, your spouse, and your children.
• We also offer other voluntary benefits which include hospital indemnity, critical illness, accident indemnity, and pet insurance plans.
• Employees receive basic life insurance, short-term disability, and long-term disability coverage at no cost.
• Our generous paid time off policy ensures you have time to relax and recharge, while our 401k plan with a company match helps you plan for your future.
• Apple equipment and a media stipend are provided for remote workspace.

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