Find & Apply For Clinical Auditor / Utilization Reviewer Jobs in Houston, Texas

Certified Professional Coder Dane Street, LLC - 2.0 Houston, TX Job Details Part-time 17 hours ago Benefits Disability insurance Health insurance Dental insurance Paid time off Vision insurance 401(k) matching Life insurance Pet insurance Qualifications Data analysis reporting Medicare Audit report preparation CMS Healthcare documentation compliance audits Audit Reporting Certified Professional Coder CMS regulatory compliance Retrospective medical coding audits Health insurance knowledge Medicare regulations Centers for Medicare & Medicaid Services (CMS) billing regulations Medicaid regulations Medicaid Regulatory compliance analysis Clinical documentation standards Healthcare claims compliance audits Full Job Description

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 the medical portion and prepare the billing and coding review portion of demand package reviews 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 Requirements 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 Benefits Join our team at Dane Street and enjoy a comprehensive benefits package designed to support your well-being and peace of mind. We offer a range of benefits including medical, dental, and vision coverage for you and your family. Additionally, we offer voluntary life insurance options for you, your spouse, and your children. We also offer other voluntary benefits which include hospital indemnity, critical illness, accident indemnity, and pet insurance plans. Employees receive basic life insurance, short-term disability, and long-term disability coverage at no cost. Our generous paid time off policy ensures you have time to relax and recharge, while our 401k plan with a company match helps you plan for your future. Apple equipment and a media stipend are provided for remote workspace.

ABOUT DANE STREET

A fast-paced, Inc. 500 Company with a high-performance culture, is seeking insightful 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 Exams and Peer Review programs that assist our clients in reaching the appropriate medical determination as part of the claims management process.