PI Medical Coding Reviewer II (CPC/RHIT/RHIA required)
Core
Review medical records for audit activities, dispute support, and claim reviews for provider pre-payment and post-payment functions.
Role type
Medical Coding Reviewer
Builds
Claim audit summaries and payment decisions
Domain
Healthcare / Medical Billing & Reimbursement
Deliverable
production ML models | product features | dashboards & analysis | research | client delivery | infrastructure | physical/clinical work
Required skills
Medical coding guidelines, diagnosis codes, CPT coding, medical terminology, anatomy and physiology, Medicaid/Medicare reimbursement guidelines, Microsoft Office Suite, Facets, medical record review, basic medical billing process
Preferred skills
Medicaid/Medicare experience, clinical background, reimbursement methodology (APC, DRG, OPPS), healthcare claim system configuration
Technologies
Facets, Microsoft Office Suite
Responsibilities
Make audit payment decisions on complex claims, research and analyze moderately complicated claims, refer suspected Fraud, Waste, or Abuse to SIU, meet productivity and quality standards, identify and implement process improvements, collaborate with internal departments for claim resolutions, respond to simple escalations and provider inquiries, prepare claim audit summaries for Medical Director review, ensure adherence to timeliness policies, identify systemic issues, backup administrative duties in medical record acquisition, identify training and quality areas
Seniority
Mid-level, hands-on IC