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 validation.

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

• Assess coding, billing, and reimbursement for services provided in inpatient hospitals and outpatient facilities.

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

• Review appeals and redeterminations in line with approved clinical and coding standards.

• Analyze appeal documentation and accurately document appeal resolutions.

• Compile case files and summaries for hearings.

• Participate in both virtual and in-person hearings.

• Meet productivity and quality benchmarks.

• Cross-train to assess various claim types.

• Support management in training, monitoring, mentoring, feedback, and education for new Coding Auditors.

• Stay updated on current coding guidelines and fulfill required Continuing Education Units (CEUs).

• Attend training sessions and scheduled meetings.

⛳️ Requirements

• Must possess at least one active professional credential from AHIMA or AAPC: CPC, COC, CCS, RHIA, or RHIT; this is required and must be maintained as a condition of employment.

• A minimum of 3 years of experience in inpatient hospital bill auditing and outpatient facility coding, with charge master review; preferred.

• Familiarity with the appeals and hearings process.

• Exceptional written communication skills, capable of crafting clear, concise, accurate, and fact-based rationales.

• Strong oral communication abilities for presenting case summaries and decisions.

• Capacity to manage multiple tasks in a dynamic production environment.

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

• Comprehensive understanding of hospital billing and charging, including UB-04s, itemized bills, revenue codes, CPT/HCPCS codes, and ICD-10 diagnosis and procedure codes.

• Competent in using Microsoft Windows, Outlook, Excel, Word, PowerPoint, internet browsers, Microsoft Teams, Zoom, and other similar virtual meeting platforms.

🏝️ Benefits

• Flexible working hours.

• Work-life balance.

• Opportunities for continuous learning and career advancement.

• Benefits commence on Day 1.

• Clear pathway for career growth.

• Training and leadership development opportunities available.

• Generous and flexible vacation policy.

• 401(k) employer matching.

• Comprehensive health benefit offerings.

• Educational assistance programs.

• Leadership and technical development academies.

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