Certified Medical Coding Auditor

This is a fully remote position, open to applicants in United States.

📋 Description

• Assess medical invoices to pinpoint suitable billing, coding, and cost-saving opportunities.

• Investigate and resolve claim inconsistencies that necessitate a higher level of expertise beyond the initial assessment.

• Collaborate with the Negotiation team to address more intricate claim challenges and secure further savings.

• Relay findings to clients via comprehensive Bill Review Reports and aid in addressing complex billing inquiries.

• Evaluate and respond to requests for bill reconsideration, including those that require additional research or analysis.

• Manage escalated provider queries, resolve conflicts, and engage in direct negotiations for billing discrepancies.

• Offer guidance and mentor junior analysts on best practices for claim reviews.

• Assist in identifying trends in billing issues, suggesting system or process enhancements, and contributing to policy formulation.

• Support training initiatives by educating internal teams and clients on updates to codes, edits, and bill review methods.

• Collaborate across departments with internal teams to pinpoint and implement process efficiencies that enhance savings and client satisfaction.

• Ensure adherence to HIPAA and other regulatory standards.

• Execute additional duties as assigned.

⛳️ Requirements

• A minimum of 3 years of experience in auditing, claims review and/or billing within a healthcare organization.

• CPC and/or CIC certification.

• Proficient understanding of industry coding, including ICD-10, CPT, HCPCS Revenue codes, etc.

• Exceptional communication abilities, both spoken and written.

• Familiarity with CMS guidelines.

• Preferred qualifications include:

• Experience in DRG validation.

• Understanding of Health Insurance, Medicare guidelines, and various healthcare programs.

• Experience with RevCycle Pro, Encoder Pro, and/or SuperCoder software.

🏝️ Benefits

• Comprehensive benefits package with generous employer contributions.

• Flexible working options, including remote work.

• 401k plan with a substantial employer match and immediate vesting.

• Opportunities for personal and professional growth.

• Supportive family benefits, including paid leave for new family additions.

• Companywide philanthropic initiative, Valenz Communities Connection.