Texas Licensed Coding Consultant

Job Summary

A company is looking for a Senior Coding Quality Analyst to evaluate medical documentation and ensure compliance with coding standards.

Key Responsibilities

• Conduct audits of medical coding to enhance accuracy and identify potential fraud, waste, and abuse
• Review and provide expertise on claims, making pay/deny recommendations based on findings
• Stay updated on Medicare guidelines and manage case review assignments effectively

Required Qualifications

• Associate's degree in Healthcare Administration, Business, or related field, or HS Diploma/GED with 2+ years of relevant experience
• Coding certification through AAPC or AHIMA
• 3+ years of experience in medical claims procedure coding and processing
• Experience interpreting Medicare and CMS claims policies
• Solid knowledge of Medicare/CMS claims regulations and policies