Lead Associate, Outpatient Coding Quality Auditor

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

📋 Description

• Carry out thorough evaluations of medical records, claims, and related documentation to ascertain the precision and suitability of assigned ICD-10-CM, CPT, HCPCS Level II codes, and modifiers.

• Utilize contract-specific review methodologies to detect coding inconsistencies, billing mistakes, reimbursement inaccuracies, and compliance issues.

• Review documentation to confirm that coding assignments are substantiated and align with relevant regulatory and payer requirements.

• Meticulously document audit results, rationale, and suggestions using proprietary audit and case management systems.

• Deliver comprehensive coding and reimbursement conclusions that are backed by clinical documentation, coding guidelines, payment methodologies, and regulatory mandates.

• Conduct continuous quality assurance audits of coding and clinical review personnel.

• Interpret and apply official coding guidelines, CMS regulations, NCCI edits, OPPS requirements, EAPG methodologies, APC payment policies, and ASC reimbursement standards.

• Evaluate auditor and reviewer performance against quality benchmarks and productivity metrics.

• Recognize opportunities for process improvement and propose corrective measures.

• Engage in inter-rater reliability activities and quality calibration sessions.

• Assist in the creation of quality monitoring processes, audit tools, and review protocols.

• Act as a subject matter expert on outpatient coding, reimbursement methodologies, and payment integrity principles.

• Meet productivity and quality performance standards established by management.

⛳️ Requirements

• One or more active professional credentials from AHIMA or AAPC: CPC, COC, CCS, RHIA, RHIT; required.

• A minimum of 3 years of experience in outpatient medical record coding is required.

• At least 3 years of experience in coding auditing, quality assurance, or coding validation is required.

• Extensive background in reviewing outpatient facility claims and medical records.

• Proven expertise in outpatient reimbursement methodologies, including Enhanced Ambulatory Patient Groups (EAPG), Ambulatory Payment Classifications (APC), and Ambulatory Surgery Center (ASC) payment systems.

• Preferred experience in conducting payment integrity, compliance, or reimbursement-focused audits.

• Preferred experience in leading quality initiatives, training staff, or acting as a coding subject matter expert.

• This is a remote position available within the United States.

🏝️ Benefits

• Benefits available starting on the first day of employment.

• Clear career advancement opportunities through training and leadership development.

• Flexible work hours.

• Work flexibility, learning, and career development.

• Generous, flexible vacation policy.

• 401(k) employer match.

• Comprehensive health benefits.

• Educational assistance.

• Leadership and technical development academies.