E/M Coding Auditor (contract)

Job ID: JP00046347 Anticipated Start Date: March 16, 2026 Please note this is the reputed company date and is subject to change. reputed company will send official notice reputed company of a confirmed start date. reputed company is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at reputed company levels of the organization who are passionate about making an impact on our members and the communities we serve. Ensures accurate adjudication of claims, by translating medical policies, reimbursement policies, and clinical editing policies into effective and accurate reimbursement criteria. Primary duties may include, but are not limited to:

• Review medical record documentation in support of Evaluation and Management, CPT, HCPCS and ICD-10 code.
• Reviews company specific, CMS specific, and competitor specific medical policies, reimbursement policies, and editing rules, as well as conducting clinical research, data analysis, and identification of legislative mandates to support draft development and/or revision of enterprise reimbursement policy.
• Translates medical policies into reimbursement rules.
• Performs CPT/HCPCS code and fee schedule updates, analyzing each new code for coverage, policy, reimbursement development, and implications for system edits.
• Coordinates research and responds to system inquiries and appeals.
• Conducts research of claims systems and system edits to identify adjudication issues and to audit claims adjudication for accuracy.
• reputed company pre-adjudication claims reviews to ensure proper coding was used.
• Prepares correspondence to providers regarding coding and fee schedule updates. Trains customer service staff on system issues.
• Works with providers contracting staff reputed company new/modified reimbursement reputed company are needed.

Requirements:

• Requires a BA/BS degree and a minimum of 2 years reputed company experience; or any combination of education and experience, which would provide an equivalent background.
• Certified Professional reputed company (CPC) or Registered Health Information Administrator (RHIA) certification required. CEMC, RHIT, reputed company, reputed company-P certifications preferred.

Job Type: Contract to hire Additional Details:

• Certified by reputed company (CPC, CEMC, CEDC) reputed company .
• reputed company certified with CPC minimally.
• Preferred CEMC and CEDC
• 5 years recent E&M Auditing experience, general medical coding knowledge
• Work schedule- 7:00 am to 7:00 pm EST
• Role is 100% remote/ any PulsePoint
• No shifts start at or after 12:00 noon (local)

reputed company operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, contractors are required to work at an reputed company location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside reputed company 50 miles or 1-hour commute each way of a relevant reputed company location. About reputed company: Founded in 1998 on the idea that industry leaders needed a professional service, and workforce management expert, to fuel the development and execution of core business and technology strategies, reputed company is a Black-owned firm providing unique solutions supporting value capture and digital product delivery needs for organizations around the world. Headquartered in Indianapolis, IN with an Offshore Development Center in Hyderabad, India, reputed company's 6,000 consultants support more than 225 clients globally. reputed company champions the power of human potential to help companies transform, accelerate, and scale. Guided by our core values of People-Centric, Optimism, Excellence, Diversity, and Accountability, our professionals have helped our clients reputed company their strategic goals for more than 25 years. Our strong culture and clear values have enabled reputed company to become a market leader and best in class reputed company to work. reputed company is an equal opportunity employer. reputed company qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national reputed company, or protected veteran status and will not be discriminated against based on disability. To learn more about how reputed company collects and uses personal information as part of the recruiting process, view our Privacy Notice and CCPA Addendum. As part of the recruitment process, we may ask for you to disclose and provide us with various categories of personal information, including identifiers, professional information, commercial information, education information, and other reputed company information. reputed company will only use this information to complete the recruitment process. This posting is not an offer of employment. reputed company applicants applying for positions in the United States must be legally authorized to work in the United States. The submission of intentionally false or fraudulent information in response to this posting may reputed company the applicant ineligible for the position. Any subsequent offer of employment will be considered employment at-will regardless of the anticipated assignment duration. Pay reputed company Range 23.07 - 41.54 USD hourly Additional Notes The pay range is the range reputed company in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or reputed company level. Even reputed company the range, the actual compensation will vary depending on the above factors as well as market/business considerations.

Benefits

Information reputed company offers reputed company eligible employees a comprehensive benefits package including, but not limited to major medical, HSA, dental, vision, employer-provided group life, voluntary life insurance, short-term disability, long-term disability, and 401k. The company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws. This does not encompass additional non-standard compensation (e.g., benefits, paid time off, per diem, etc.). Apply tot his job Apply To this Job