Licensed Clinical Coding Investigator

To ensure compliance and accuracy in medical coding, the part-time Licensed Clinical Coding Investigator will perform quality audits, analyze claims against medical records, and provide coding expertise while working remotely. Key responsibilities: Conducts quality audits of clinical review cases for CPT, HCPCS, and modifiers in a telecommuting environment Determines the accuracy of medical coding and payment recommendations for pre-payment claims Identifies aberrant billing patterns and trends, recommending providers for review as necessary Required qualifications: High School Diploma/GED Certified Coder (AHIMA or AAPC) or active Nurse license with medical record auditing experience 2+ years of experience in coding (CPT/HCPCS/ICD) or as a licensed nurse with coding experience 2+ years of experience with health insurance terminology and regulatory guidelines Intermediate computer skills, including proficiency with Microsoft and Adobe applications