Lead Coding Auditor, Itemized Bill Review and Appeals

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

📋 Description

• Conduct detailed reviews of itemized bills, charts, and coding validations.

• Confirm that billed services and procedures were executed, authorized, documented, and reimbursed in accordance with plan policies and provider contracts.

• Assess documentation for precise coding, charging, and reimbursement for both inpatient hospital and outpatient facility services.

• Utilize proprietary auditing systems to record audit findings and their justifications.

• Examine appeals and redeterminations in line with approved clinical and coding guidelines.

• Analyze appeal documentation and clearly and accurately document decisions while adhering to production and quality standards.

• Prepare case files and summaries for hearings and engage in virtual or on-site hearings.

• Meet productivity and quality performance benchmarks.

• Acquire cross-training to evaluate various claim types.

• Support management in training, monitoring, mentoring, providing feedback, and educating new Coding Auditors.

• Keep up-to-date with current coding guidelines and fulfill required CEUs.

• Participate in training sessions and scheduled meetings regarding clinical policies, procedures, rules, and regulations.

⛳️ Requirements

• Hold at least one active professional credential from AHIMA or AAPC: CPC, COC, CCS, RHIA, or RHIT, required as a condition of employment.

• Possess 3+ years of experience in inpatient hospital bill auditing and outpatient facility coding, including charge master reviews.

• Have a working understanding of the appeals and hearings processes.

• Exhibit excellent written communication skills for crafting clear, concise, accurate, and fact-based appeal rationales.

• Demonstrate strong oral communication skills for presenting case summaries and decisions.

• Ability to manage multiple tasks in a fast-paced production environment.

• Proficient in medical record auditing and coding methodologies including ICD-10-CM, ICD-10-PCS, APC, ASC, HCPCS, and CPT.

• Possess a solid understanding of hospital billing and charging processes, including UB-04s, itemized bills, revenue codes, and coding systems like CPT/HCPCS and ICD-10.

• Proficient with Microsoft Windows, Outlook, Excel, Word, PowerPoint, internet browsers, Microsoft Teams, Zoom, and virtual meeting tools.

• Willingness to travel up to 25% for on-site hearing testimony.

🏝️ Benefits

• Benefits commence on your first day of employment.

• Clear pathways for career advancement with continuous training and leadership development.

• Flexible working hours.

• Generous and flexible vacation policy.

• 401(k) employer matching.

• Comprehensive health benefits.

• Educational assistance.

• Leadership and technical development academies.

• Work flexibility.

• Up to 25% travel for on-site hearing testimony.