Inpatient and Facility Coding Auditor, Claims Review Specialist

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

📋 Description

• Act as a consultant for revenue cycle and coding in collaboration with the Director of HIM.

• Conduct intricate concurrent and retrospective audits of claims for hospital inpatient, facility, and outpatient services.

• Assess the accuracy of coding and compliance with documentation by verifying ICD-10, CPT, and HCPCS code assignments following CMS, AHIMA, AHA Coding Clinic, and other official coding guidelines.

• Utilize proprietary software to analyze claim and coding data.

• Identify areas for improvement in coding, billing, and the revenue cycle.

• Create standardized reports and convey audit findings to clients.

• Offer coding education and address client inquiries.

• Draft written guidance and FAQs.

• Assist in client meetings.

• Work in conjunction with the revenue cycle consulting team to enhance compliance, operational excellence, and reimbursement optimization.

• Examine findings and pinpoint potential root causes of discrepancies.

• Compile summary reports with relevant supporting references.

• Conduct a second-level review of processes and code assignments for compliance assurance.

• Investigate, analyze, and respond to inquiries related to compliance, coding, and denials.

• Safeguard patient health and client information confidentiality, adhering to AHIMA Standards of Ethical Coding and established coding guidelines.

• Execute assigned audits while achieving record-type productivity standards and maintaining a minimum billable productive-hours threshold of at least 80% when client work is available.

• Deliver audit outputs within specified timelines.

• Perform independent QA of assigned audit results prior to the final QA review, with a minimum accuracy expectation of 95%.

• Accurately and promptly report work time and outcomes.

• Foster respectful communication with colleagues and encourage teamwork and knowledge sharing.

• Engage professionally with clients and support the company’s business objectives.

• Provide management with schedules detailing planned work activities, events, locations, and any changes.

• Maintain professional credentials and stay updated on coding, reimbursement, and compliance knowledge through ongoing education.

• Travel periodically as necessary.

• Perform other assigned responsibilities.

⛳️ Requirements

• Active credential from AHIMA or AAPC is required; CCS, CPC, or RHIT are necessary.

• A minimum of five (5) years of coding and/or auditing experience in an acute care hospital or healthcare consulting setting, covering inpatient and facility services.

• Comprehensive understanding of ICD-10-CM/PCS, CPT, HCPCS, reimbursement methodologies, regulatory compliance, and audit best practices.

• Proficiency in electronic health record (EHR) systems, including Epic, Cerner/PowerChart, Meditech, and other healthcare applications.

• Advanced analytical, critical-thinking, and problem-solving abilities, with the capacity to interpret intricate clinical, coding, and regulatory information.

• Strong computer skills, including expertise in Microsoft Office applications and auditing/reporting software.

• Exceptional written and verbal communication skills, with the capability to present findings and deliver clear, client-focused guidance to both operational and executive audiences.

• Proven ability to juggle multiple projects, client engagements, and priorities while working independently with minimal oversight.

• Highly organized with a keen attention to detail, accuracy, and a dedication to ethical coding and auditing practices.

• Experience working remotely and collaborating effectively in a team-oriented, consulting-driven environment.

• Ability to effectively engage with multiple clients, diverse stakeholders, and cross-functional teams while upholding productivity and quality standards.

• Capability to work at a computer terminal for 6-8 hours daily.

• Infrequent ability to lift and relocate materials weighing up to 20 lbs.

🏝️ Benefits

• Quality of life with a remote, predictable, full-time schedule.

• Comprehensive Medical, Dental, and Vision coverage, among other benefits.

• Long-term disability insurance.

• Life insurance coverage.

• Generous parental leave policy.

• 401K plan with company match.

• Certification and Tuition Reimbursement options.

• Paid holidays.

• Flexible Time Off policy.