MUST ALREADY HAVE EXPERIENCE DOING BILL AUDIT REVIEWS FOR DIFFERENT STATES.

We are seeking an experienced CPC-certified medical coder with multi-state experience to perform coding audits, utilization reviews, demand package reviews, and provide litigation support including deposition and testimony services as needed. The ideal candidate must have experience reviewing medical records and billing across multiple states and payer environments.

Responsibilities:

• 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

Required Qualifications:

• 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

Preferred Experience:

• RAC, UPIC, or commercial payer audit response

• Multi-state Medicaid policy interpretation

• Expert witness experience in civil litigation

• Data analysis and audit trend reporting

This position may be structured as part time Candidates must be comfortable reviewing policies and payer rules across multiple jurisdictions and is able to do multiple types of reviews/audits