Pre-Payment Clinical Auditor (RN/Medical Coder) | 5 Years of Experience | Remote | Contract

Walker Healthforce is seeking a Pre-Payment Clinical Auditor (RN/Medical Coder) with 5 years of combined experience in clinical auditing, medical coding, payment integrity, or related healthcare reimbursement functions to investigate complex healthcare claims, validate medical coding accuracy, and ensure compliance with medical necessity and reimbursement guidelines. This is a Contract opportunity.

Start Date: ASAP

Location: Remote – Nationwide, excluding NY, CA, HI, and AK

Hours/Schedule: Monday-Friday, 40 hours

Worker Type: W2

Core Requirements:

• 5 years of combined experience in clinical auditing, medical coding, payment integrity, SIU investigations, utilization management, healthcare compliance, or related healthcare reimbursement functions.

• Active Registered Nurse (RN) license.

• Active, nationally recognized coding certification through AAPC (CPC, COC, CIC, CPMA) or AHIMA (CCS, CCS-P, RHIT, RHIA).

• Proficiency in CPT, HCPCS Level II, ICD-10-CM, and medical record documentation review.

• Experience performing medical record reviews, claims audits, and medical necessity assessments.

• Knowledge of CMS reimbursement methodologies, NCCI edits, and applicable federal and state coding regulations.

• Experience identifying fraud, waste, abuse, and healthcare billing irregularities.

We Consider It A Bonus If You Also Have:

• Behavioral health coding and auditing experience.

• Knowledge of DSM-5 documentation requirements.

• Experience auditing mental health, substance use disorder, psychiatric facility, or behavioral health outpatient claims.

Job Responsibilities:

• Investigate complex healthcare claims for potential fraud, waste, abuse, and billing irregularities.

• Review medical records and claims to validate coding accuracy and documentation compliance.

• Conduct pre-payment clinical and technical audits of complex and high-dollar claims.

• Evaluate medical necessity and adherence to applicable medical policies.

• Validate coding against CPT, HCPCS, ICD-10-CM, ICD-10-PCS, and Official Coding Guidelines.

• Analyze third-party referrals, compliance tips, and external allegations of suspicious billing activity.

• Prepare audit summaries and collaborate with Medical Directors and compliance teams.

• Support referrals to Special Investigations, Provider Performance, and Compliance teams when appropriate.

What We Offer:

• Competitive compensation package

• Weekly pay via Direct Deposit

• Medical, Dental & Vision available

• 401k options

Why Work With Walker?

• Access to our top ranked team of recruiting and placement specialists

• Continuous, one-on-one support from a dedicated engagement manager

• Professional resume development and interview preparation

Contact our Recruiting Team today to experience the Walker Healthforce difference!

About Us:

Walker Healthforce is known as the dominant force of performance, precision, expertise, and integrity in the healthcare consulting community! As a certified WMBE, we provide end-to-end healthcare IT and clinical solutions to hospitals, health systems, and payer organizations, including Fortune 100 firms nationwide. We are healthcare experts, we're custom not commodity and we've been exceeding expectations for nearly 20 years. Join forces with us to experience unparalleled results today!

We are an Equal Opportunity Employer committed to a culturally diverse workforce. All qualified applicants will receive consideration for employment.