Outpatient Payment Integrity Production Coder (Medical Coding)

Location: Remote

Salary: $58,000–$65,000 per year

Company

hirify.global supports outpatient payment integrity operations through claim-level coding reviews that identify inaccurate or unsupported billing and recover client savings.

What you will do

• Perform outpatient coding reviews using medical records, itemized bills, claim lines, payer requirements, CPT/HCPCS guidance, ICD-10-CM guidelines, revenue codes, modifiers, NCCI edits, and reimbursement methodologies.
• Validate billed services, procedure codes, modifiers, units, revenue codes, billing combinations, and supporting documentation.
• Identify unbundling, unsupported services, incorrect code selection, unit errors, modifier issues, documentation deficiencies, and other payment integrity findings.
• Document clear, concise, and defensible audit rationale, including code changes, unsupported findings, documentation gaps, and references used.
• Meet production, quality, and turnaround expectations while managing multiple claims and escalating complex questions to leads or subject matter experts.
• Participate in training, calibration, quality feedback, and target refreshers while maintaining current knowledge of outpatient coding and payer requirements.

Requirements

• Current, nonexpired coding certification required: CPC, COC, CCS, RHIT, RHIA, or equivalent.
• At least 3 years of outpatient coding experience required.
• Strong knowledge of CPT, HCPCS, ICD-10-CM, revenue codes, modifier usage, NCCI edits, outpatient documentation standards, and payer-specific coding requirements.
• Experience reviewing outpatient facility claims, medical records, operative reports, emergency department records, observation records, ancillary services, injections and infusions, or surgical procedures.
• Ability to interpret payer policy, CMS guidance, LCDs/NCDs, coding references, and documentation requirements for claim-level reviews.
• Strong written communication, analytical thinking, attention to detail, independent judgment, and ability to meet productivity and quality targets.

Nice to have

• Payment integrity, outpatient facility audit, payer review, or claims review experience.
• Experience with APC, EAPG, OPPS, multiple procedure reductions, packaging, bundling, and payer-specific reimbursement rules.
• Experience with 3M, TruCode, WebStrat, payer portals, claim systems, Optum platforms, or similar coding and review tools.

Culture & Benefits

• Remote full-time work in a production-oriented environment.
• Work is governed by company policies, client requirements, confidentiality standards, HIPAA requirements, and coding compliance expectations.
• Quality review, calibration activities, training, and feedback support consistent application of audit criteria.
• Confidentiality, objective judgment, and accurate and ethical claim review are required.