Medical Coding Specialist

Company Description

Lumen Solutions Group Inc. is a technology consulting Services company based in Florida. We provide a wide array of experienced business and IT professionals supporting clients from solution design to implementation and support. We specialize in professional IT consulting services, IT Staffing, Business/IT Strategy, Business Process Blueprints, Enterprise Architecture, Enterprise Transformation.

**Job Title: Medical Coding Specialist

Location: Remote (primarily remote; onsite once a quarter or as needed)

Type: Contract to Hire**

Job Summary:

We are seeking experienced and certified Medical Coders to join our Special Investigation Unit (SIU) at CareFirst. This team plays a critical role in fraud detection and prevention, focusing on prepayment claim reviews.

Responsibilities:

• Review medical records and claims for coding accuracy and compliance.
• Identify potential fraud, waste, or abuse through prepayment reviews.
• Apply correct CPT, ICD, and HCPCS codes per medical and payment policies.
• Make recommendations for claim approval or denial.
• Collaborate with investigators and SIU team members.
• Utilize coding tools such as Optum or Coder Pro.

Qualifications:

• 2-3 years of medical coding experience.
• Certification required: CPC, CPMA, CCA, or COC (CPCA not accepted).
• Strong knowledge of fraud detection, claims policies, and medical policy guidelines.
• Familiarity with prepayment review workflows preferred.

Lumen Solutions Group Inc is an equal opportunity employer. All qualified applicants will be considered for employment without regard to any legally protected status.