Open role
Coding Auditor
The Coding Auditor is a professional auditing role designed for a certified professional coder. Under direct supervision of Healthcare Fraud Shield SIU management, this position executes routine coding reviews to ensure health records align accurately with billed ICD-10-CM, CPT, HCPCS, Revenue codes. The ideal candidate has a strong foundation in primary medical coding and a keen eye for detail, eager to learn complex audit frameworks, regulatory policies, and documentation validation.
Key Responsibilities
- Compare the procedures and codes billed on a claim to a medical record.
- Compare information submitted on the claims in order to determine amount and nature of billable services as needed.
- Determines appropriateness of billing and reimbursement as needed.
- Documents findings for each claim line in a spreadsheet as needed.
- Summarize findings in a written report as needed.
- Abstracts CPT, HCPCS, Revenue Codes, DRG codes, and ICD-10 from medical records as needed.
- Responsible for maintaining current knowledge of coding guidelines and relevant federal and/or state regulations as needed.
- Understands and complies with all company Privacy and Security standards.
- Employee may not use or disclose any protected health information, except as otherwise permitted, or required, by law.
- On average, there are a minimum of 5-10 claim line reviews per hour.
- Other duties as needed.
Skills, Knowledge and Expertise
- Knowledge of medical terminology.
- Knowledge of coding including CPT, HCPCS, Revenue Codes, DRG Codes, and ICD-10.
- Knowledge of specialty medical practices.
- Must be detail oriented.
- Ability to communicate effectively both verbally and in writing.
- Strong listening skills.
- Independent.
- Responsible.
- Self-disciplined.
- Ability to meet defined performance and production goals.
- Strong computer skills.
- This job requires access to confidential and sensitive information, requiring ongoing discretion and secure information management.
- Minimum of one year of investigative experience is required.
- Required to have one of the following: CPC, CCS, CCA
Benefits
- Medical, Dental & Vision insurance
- 401(k) retirement savings with employer match
- Vacation and sick paid time off
- 7 paid holidays & 2 floating holidays
- Paid maternity/paternity leave
- Disability & Life insurance
- Flexible Spending Account (FSA)
- Employee Assistance Program (EAP)
- Professional and career development initiatives
- Remote work eligible
- Must have high speed Internet (satellite is not allowed for this role) with a minimum speed of 25mbs download and 5mbs upload.
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