Seeking knowledgeable, certified, and detail-oriented professional clinical coders to provide expert coding review services for charts from our clients.

Key Responsibilities:

• Coding Audit and Validation: Perform retrospective audits of medical charts to validate CPT/HCPCS, ICD-10-CM, and modifier usage.

• Compliance and Guideline Adherence: Ensure all coding complies with CMS regulations, AMA 2023 E/M guidelines, and client-specific coding standards.

• Documentation Review: Confirm that clinical documentation adequately supports medical necessity for all services billed.

• Risk Identification: Identify and report on common coding risk areas, including but not limited to:

  • Upcoding or down-coding of E/M levels.

  • Incorrect application of prolonged services or consultation codes.

  • Improper new vs. established patient coding.

  • Inappropriate modifier usage (e.g., -25, -24, -59).

• Continuous Learning:

  • Maintain up-to-date knowledge of CMS requirements, state and federal regulations, and other compliance standards relevant to the services.

• Required Qualifications & Experience:

  • Certification: Must hold a current, active certification from AAPC (CPC, CEMC, COC, CIC) or AHIMA (CCS, CCS-P).

Experience:

• A minimum of two (2) years of total coding experience.

• At least one (1) year of this experience must be in Physician-based (Evaluation and Management) coding.

  Skills:

  • Demonstrated experience with the clinical and administrative documentation required to support CPT and Diagnosis codes.

• Training & Development:

  Initial, comprehensive training and certification will be provided by the client upon meeting performance benchmarks.

  The client will be responsible for your ongoing training to ensure you remain current with all coding standards, regulatory changes, and certification requirements.