Medical Coder - CPC) – AAPC required

Company: MEDVA

Job Title: Medical Coder
 Schedule: Monday – Friday, 8:00 AM – 4:30 PM EST
 EMR: eClinicalWorks (eCW)
Credentials Required: CPC (AAPC)
RATE: $7/hr
Position Summary
The MedVA CPC – Coder/Auditor is responsible for performing detailed reviews of provider documentation, coding accuracy, and claim integrity to ensure compliance with CPT, ICD-10, and payer-specific guidelines. This role serves as a critical quality checkpoint within the revenue cycle, supporting accurate charge capture, denial prevention, and audit readiness.
The ideal candidate will bring strong experience in ENT & Allergy coding and billing, along with a deep understanding of documentation requirements, regulatory compliance, and audit standards.
Key Responsibilities
Coding & Documentation Review
* Review provider documentation to ensure accurate assignment of CPT, ICD-10, and modifiers
* Validate that documentation fully supports services billed prior to claim submission
* Identify coding discrepancies, undercoding, overcoding, or missing documentation elements
* Ensure proper linkage of ICD-10 diagnoses to CPT codes based on medical necessity
Claim Work Queue Review
* Perform pre-bill and/or post-bill audits from designated claim work queues
* Analyze claims for compliance with AMA CPT guidelines, ICD-10-CM standards, payer policies, and applicable federal and state healthcare regulations
* Ensure adherence to CMS guidelines, medical necessity requirements, and applicable billing compliance rules, including awareness of OIG Work Plan focus areas and False Claims Act risk considerations
* Flag and correct issues prior to submission or escalate as needed
* Assist in reducing denials and compliance risk through proactive claim review
Audit & Compliance
* Conduct structured chart audits to evaluate documentation completeness, coding accuracy, and regulatory compliance
* Document audit findings and track trends, risks, and opportunities for improvement
* Support internal compliance initiatives, audit preparedness, and risk mitigation strategies
* Maintain audit documentation in accordance with organizational audit protocols
Allergy Specialty Focus
* Apply advanced knowledge of Allergy CPT codes, including but not limited to:
* 95165 – Allergen immunotherapy preparation
* 95117 – Immunotherapy administration (2+ injections)
* 95004 – Percutaneous allergy testing
* Review high-risk and high-volume allergy services for accurate billing, documentation support, and payer compliance
* Ensure adherence to payer-specific policies for allergy testing, antigen preparation, and immunotherapy services
Education & Feedback
* Provide clear, actionable feedback based on audit findings
* All findings and audit results are initially reported to the Coding Manager
* Participate in provider and staff education as directed, once findings are validated and approved for escalation
* Identify trends and opportunities for provider documentation improvement
* Collaborate with Coding, Compliance, and RCM leadership on education and training initiatives
Qualifications
Required (Non-Negotiable)
* Certified Professional Coder (CPC) – AAPC required
* Minimum 3–5 years of medical coding experience
* Strong knowledge of CPT, ICD-10-CM, and HCPCS coding guidelines
* Experience performing coding audits and documentation validation
* Familiarity with EMR systems (eCW preferred) and claim work queues
Preferred ( Nice to have but not required)
* Experience with Allergy, ENT, or multi-specialty coding
* Auditing credentials (e.g., CPMA preferred)
* Experience in coding QA, compliance, or audit-focused roles
* Strong understanding of payer policies, NCCI edits, and medical necessity requirements
Why Join Us?
* Work U.S. Hours, Stay Remote – Enjoy a stable Monday–Friday, 8:00 AM – 4:30 PM EST schedule
* Specialize in High-Demand Coding Areas – Gain deep expertise in Allergy and ENT coding
* Make a Real Impact – Play a critical role in ensuring accurate billing, reducing denials, and supporting compliance
* Collaborative Team Environment – Work closely with Coding, Compliance, and RCM leadership
* Growth Opportunity – Develop your skills in auditing, compliance, and provider education
* Fully Remote – Work from anywhere with a reliable internet connection
Reporting Structure
* Reports to: Coding Manager

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