Medical Coding Specialist

Overview

On Site
$35 - $35 hr
Contract - W2
Contract - Independent
Contract - 3+ mo(s)

Skills

CPC
CPMA
COC
INVESTIGATIONS
SIU
FWA
FRAUD
MEDICAL CODER
MEDICAL CODING
CPT
ICD 10

Job Details

Now Hiring:Medical Coding Specialist

Remote - Occasional Onsite as Needed | High Preference - DC / MD / VA / WV Region
$35/hour W2 (No Benefits) | Full-Time | Contract-to-Hire

About the Role:

Join a mission-critical Special Investigations Unit (SIU) tasked with safeguarding healthcare integrity. With over 5,000 claims pending review, we re seeking a certified medical coder to assist in pre-payment claims audits ensuring accurate billing, regulatory compliance, and proactive fraud, waste, and abuse (FWA) detection.

This is more than coding this is your opportunity to protect payment integrity, guide provider billing practices, and make an impact on value-based reimbursement strategies.

Key Responsibilities:

  • Review provider claims and medical records for proper coding per AMA and industry standards.

  • Evaluate for FWA indicators and determine pre-payment compliance.

  • Act as a subject matter expert in CPT, ICD-10, HCC, and risk adjustment methodologies.

  • Consult with internal teams (Policy, Contracting, Provider Relations) to interpret coding implications on VBC (Value-Based Contracting) and STAR ratings.

  • Assist in building provider guides and resources for compliant code submission.

  • Stay current with regulatory coding updates (CPT/ICD10 changes, CMS guidance).

Must-Have Qualifications:

  • CPC, CPMA, or COC certification (AAPC required).

  • 3+ years of coding experience, including:

    • Risk adjustment (HCC)

    • Ambulatory or CRC coding

    • Managed care or health plan environments

  • Strong understanding of medical records, coding compliance, and claim review workflows.

  • High school diploma or equivalent.

Preferred Qualifications:

  • Bachelor s degree in a healthcare-related discipline.

  • Experience in:

    • Medical auditing

    • Provider education/training

    • Revenue cycle and VBC models

  • Prior SIU, FWA, or prepayment review experience.

  • Skilled in Excel, Word, PowerPoint, and audit tracking systems.

Top Skills & Traits:

  • Analytical thinker with strong attention to detail.

  • Excellent written and verbal communicator.

  • Comfortable reviewing large volumes of data.

  • Able to collaborate with cross-functional teams and explain complex coding rules in clear terms.

Why This Role Matters:

The SIU is at a critical juncture with growing case volume. This role will directly impact timely and accurate claims processing, contribute to regulatory compliance, and protect the organization from improper payments and coding abuse.

Contract-to-Hire Opportunity
Stability + High-Impact Work
Be the expert others rely on.

Interested candidates should apply directly or message us for more details.

#MedicalCoding #CPMA #CPC #FWA #ClaimsReview #SIUJobs #QualityAssurance #ValueBasedCare #HealthcareJobs

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