Medical Coding
Core
Review and validate CPT, ICD-10-CM, and HCPCS codes for accuracy; investigate complex medical claims to identify fraud, waste, and abuse while ensuring clinical documentation integrity.
Role type
Senior IC medical coding and clinical investigation analyst
Builds
Payment integrity and coding accuracy for global healthcare clients
Domain
Healthcare / Medical Billing & Compliance
Required skills
CPC certification, ICD-10-CM, CPT coding, HCPCS coding, Clinical Documentation Improvement (CDI), Medical Record Review, Anatomy, Pathology, Physiology, Anesthesia, E/M coding, Surgical coding, Emergency Department coding, Medical Necessity Review
Preferred skills
Knowledge of National Correct Coding Initiative (NCCI), CMS guidelines, HIPAA compliance, Fraud, Waste & Abuse (FWA) identification
Technologies
CPT, ICD-10-CM, HCPCS, CMS guidelines, NCCI
Responsibilities
Review and validate medical codes for accuracy; Analyze medical records to ensure appropriate code selection; Identify coding discrepancies, upcoding, and downcoding; Apply clinical expertise to determine medical necessity and reimbursement appropriateness; Prepare investigation summaries with supporting clinical rationale; Participate in quality audits and calibration sessions.
Seniority
Mid-level, hands-on IC
