Certified Clinical Coder (Registered Nurse) - 244094

Medix provides workforce solutions to clients and creates opportunity for talent in the Healthcare, Life Sciences, Engineering and Technology fields. Through our core purpose of positively impacting lives, we have earned our reputation as an industry leader by providing unsurpassed customer service and top quality professionals to our clients.

Clinical Coder – Special Investigations Unit Schedule: Full-Time | Monday–Friday, 9:00 AM–5:00 PM Work Setting: REMOTE (Must live in NY state) Join a mission-driven organization committed to empowering communities through equitable, accessible health care. We are looking for a Clinical Coder to join our Special Investigations Unit (SIU). In this key role, you will help prevent and detect fraud, waste, and abuse (FWA) in healthcare claims, ensuring integrity across the system.

Review medical records and claims to ensure accuracy and compliance with applicable coding regulations and internal policies. Audit high-risk claims and billing patterns to detect FWA and enforce compliance. Collaborate with SIU investigators to assess potentially fraudulent practices such as upcoding, over-utilization, or billing for unnecessary services. Prepare detailed medical review reports, including findings, rationale, sources, and recommendations for corrective action. Present findings to internal stakeholders and participate in provider calls to explain outcomes and review rationales. Assist with documentation for audits, legal/compliance reviews, recoupments, and regulatory inquiries. Maintain thorough case documentation, including coding discrepancies and provider communications. Stay current on evolving coding standards, healthcare regulations, and fraud detection methodologies. Support ad hoc audits and special projects as assigned.