Certified Medical Coding Auditor

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

📋 Description

• Examine medical bills to pinpoint suitable billing, coding, and savings opportunities.

• Assess and resolve discrepancies in claims that necessitate a higher level of expertise beyond the initial review.

• Collaborate with the Negotiation team to address more intricate claim issues and achieve additional savings.

• Convey findings to clients via comprehensive Bill Review Reports and assist in addressing complex inquiries related to bills.

• Evaluate and respond to bill reconsideration requests, including those that demand further research or analysis.

• Manage escalated inquiries from providers, resolve disputes, and engage in direct negotiations regarding billing discrepancies.

• Offer guidance and mentor junior analysts in best practices for claim review.

• Aid in identifying patterns in billing issues, suggest enhancements to systems/processes, and contribute to policy formulation.

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

• Collaborate cross-functionally with internal teams to discover and implement process efficiencies that enhance savings and client satisfaction.

• Ensure adherence to HIPAA and other regulatory requirements.

• Carry out additional duties as assigned.

⛳️ Requirements

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

• CPC and/or CIC certification is required.

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

• Strong communication skills, both verbal and written.

• Familiarity with CMS guidelines is essential.

• 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

• Competitive benefits package featuring generous employer subsidies.

• Flexible working arrangements, including remote options.

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

• Opportunities for personal and professional development.

• Supportive family benefits, which include paid leave for new family members.

• Company-wide philanthropic initiative, Valenz Communities Connection.