Review Emergency Department cases remotely to validate billed level-of-care codes against the clinical documentation and services provided. The work is focused on structured coding review rather than full medical necessity determinations, with daily case volume expectations and close attention to documentation accuracy.
Key Responsibilities
- Perform daily reviews of ED cases to assess level-of-care coding accuracy.
- Verify that documented services align with the billed procedure and care level.
- Use structured review guidelines to evaluate coding consistency across cases.
- Complete assigned reviews in a timely manner and meet daily productivity expectations.
- Coordinate with internal teams to clarify documentation or coding discrepancies.
- Maintain detailed, consistent evaluations across a repetitive review workflow.
- Navigate review platforms and document findings accurately.
Required
- Active MD license.
- Recent hands-on Emergency Department clinical experience within the last 5-7 years.
- Strong understanding of ED level-of-care coding and clinical documentation requirements.
- Ability to manage and complete assigned case volumes daily.
- Basic computer proficiency and ability to use review platforms.
Preferred
- Prior experience in utilization management case reviews.
- Prior experience in coding validation.
- Prior experience in pharmacy claims review.
Benefits & Perks
- Remote work.
- Contract engagement.
- Committed schedule of 7.5 hours per day, 5 days per week for 1 year.