About this role
Role Overview
- Perform comprehensive medical coding audits (ICD-10-CM, CPT, HCPCS)
- Conduct utilization reviews to assess medical necessity and documentation compliance
- Review and prepare demand packages 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
Requirements
- 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.
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.