Job Opportunity: Coder, Bill Reviewer, Payment Integrity Reviewer

Employment Type: Full-time Location Type: Remote

Position Overview

Dane Street is seeking highly motivated Coders, Bill Reviewers, and Payment Integrity Reviewers to join our team. This role offers an exciting work environment, competitive compensation, and strong growth potential. You will leverage your clinical knowledge to review reports accompanying medical records, ensuring accuracy in medical billing and coding for our group health program. Collaboration with other reviewers and their office teams is essential for information clarity and timely report submission within client deadlines.

Core Duties & Responsibilities

• Evaluate the appropriateness of codes against established program standards.
• Ensure medical records are correctly matched with codes; obtain records if mismatched.
• Apply policy guidelines and healthcare terminology to determine criteria fulfillment.
• Assess claims for conflicts of interest and criteria appropriateness.
• Work within established program timeframes.
• Provide strong customer service, collaborating with clients on a case-by-case basis for quality assurance.
• Offer clinical oversight for complex cases requiring additional review.
• Serve as an additional layer of Quality Assurance and clinical knowledge for cases with quality issues.

Requirements

Required Education & Experience:

• Must possess a CPC, APCC, or DRG coder certification.
• Payment integrity or professional bill review experience is strongly preferred.
• Out-of-network bill review experience is a plus.
• Experience working in a remote environment is preferred.
• Experience in a medical office or healthcare background is required.
• CPC, CCS, or CCA certification is preferred, but not required.
• Must have access to your own billing references/engine.
• Deposition/Testimony experience is preferred, but not required.
• Extensive knowledge of Texas billing resources (e.g., FairHealth, Medicaid Texas, Texas Healthcare).
• Coding counter-audit experience is a plus.

Required Skills:

• Ability to work with a sense of urgency and meet deadlines.
• Self-motivated with a strong drive for performance excellence.
• Excellent written and verbal communication skills.
• Proficiency in navigating various computer programs (Experience with Google Chrome, Gmail, Docs, Sheets, etc., is a plus).
• Attention to detail is REQUIRED.

Security Awareness: Dane Street will never conduct interviews via text or request checks from candidates for purchasing equipment.

Benefits

We offer generous Paid Time Off, an excellent benefits package, and competitive salary. If you are an outstanding candidate, thrive in a fast-paced environment, and are interested in doing meaningful work, we encourage you to apply!

About Dane Street

Dane Street is a fast-paced, Inc. 500 Company with a high-performance culture, seeking insightful, astute, and forward-thinking professionals. We process over 200,000 insurance claims annually for leading national and regional Workers’ Compensation, Disability, Auto, and Group Health Carriers, Third-Party Administrators, Managed Care Organizations, Employers, and Pharmacy Benefit Managers. We provide customized Independent Medical Exam and Peer Review programs that assist our clients in reaching appropriate medical determinations as part of the claims management process.

Additional Details:

• Employment Type: Full-time
• Workplace: Remote
• Language: English
• Published: 2025-01-30