Job description
MUST ALREADY HAVE EXPERIENCE DOING BILL AUDIT REVIEWS FOR DIFFERENT STATES.
We are seeking an experienced CPC-certified medical coder with multi-state experience to perform coding audits, utilization reviews, demand package reviews, and provide litigation support including deposition and testimony services as needed. The ideal candidate must have experience reviewing medical records and billing across multiple states and payer environments.
Responsibilities:
Perform comprehensive medical coding audits (ICD-10-CM, CPT, HCPCS)
Conduct utilization reviews to assess medical necessity and documentation compliance
Review the medical portion and prepare the billing and coding review portion of demand package reviews 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
Required Qualifications:
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
Preferred Experience:
RAC, UPIC, or commercial payer audit response
Multi-state Medicaid policy interpretation
Expert witness experience in civil litigation
Data analysis and audit trend reporting
This position may be structured as part time Candidates must be comfortable reviewing policies and payer rules across multiple jurisdictions and is able to do multiple types of reviews/audits
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.
ABOUT DANE STREET:
A fast-paced, Inc. 500 Company with a high-performance culture, is seeking insightful forward-thinking professionals. We process over 200,000 insurance claims annually for leading national and regional Workers’ Compensation, Disability, Auto, and Group Health Carriers, Third-Party Administrators, Managed Care Organizations, Employers, and Pharmacy Benefit Managers. We provide customized Independent Medical Exams and Peer Review programs that assist our clients in reaching the appropriate medical determination as part of the claims management process.
Originally posted on Himalayas
Who can apply
Eligible countries: United States. Accepted UTC offsets: UTC-10, UTC-9, UTC-8, UTC-7, UTC-6, UTC-5, UTC+14. Review the full description for employer-specific work authorization, residency and schedule requirements.