Outpatient Payment Integrity Production Coder

Position Summary: MedReview is looking for a Outpatient Payment Integrity Production Coder . The Outpatient Payment Integrity Production Coder is responsible for completing claim-level outpatient coding reviews to identify inaccurate coding, unsupported billing, documentation gaps, and potential overpayments. This role supports payment integrity operations by applying outpatient coding expertise, client payer policy, CMS guidance, CPT/HCPCS requirements, modifier rules, NCCI edits, and medical record documentation standards to ensure audit findings are accurate, defensible, and client savings consistently recovered. Key Responsibilities Perform outpatient coding reviews using medical records, itemized bills, claim lines, payer requirements, CPT/HCPCS guidance, ICD-10-CM guidelines, revenue codes, modifier rules, NCCI edits, APC/EAPG logic, and supporting documentation. Validate whether billed outpatient services are supported by documentation and whether the correct procedure codes, modifiers, units, revenue codes, and billing combinations were reported. Identify coding discrepancies, unsupported services, unbundling, inappropriate modifier usage, incorrect procedure code selection, unit errors, documentation deficiencies, and other outpatient payment integrity findings. Apply approved audit target guidance, job aids, payer policy, coding hierarchy, and documentation standards consistently across assigned claims. Document audit rationale clearly and defensibly, including supported findings, unsupported findings, code changes, modifier issues, documentation gaps, and references used to support the review decision. Meet production, quality, turnaround time, and general professional expectations while maintaining accuracy and consistency. Escalate complex coding, payer policy, reimbursement, pricing, workflow, or documentation questions to the appropriate lead, manager, or subject matter expert. Participate in training, calibration reviews, quality feedback sessions, a