Medical Coder, Audit Specialist

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

📋 Description

• Evaluate medical records, claims, and related documentation to ensure coding accuracy and adherence to Indiana Health Coverage Programs, CMS, AMA, and other relevant regulations.

• Independently conduct thorough coding audits and documentation assessments.

• Detect coding errors, documentation shortcomings, billing anomalies, and potential compliance issues.

• Maintain comprehensive audit workpapers that detail procedures, records examined, findings, and conclusions.

• Present initial findings and suggestions to audit leadership.

• Utilize Microsoft Excel to organize, analyze, and verify audit outcomes and claims data.

• Compile audit reports, summaries, and supporting documents for both internal and external stakeholders.

• Identify patterns and trends that indicate billing mistakes, documentation issues, or opportunities for process enhancement.

• Assist with appeal reviews and audit response tasks.

• Research and interpret Indiana Medicaid policies, bulletins, and reimbursement guidelines.

• Maintain internal resources for coding guidance, regulatory updates, and auditing materials.

• Keep up-to-date with CPT, HCPCS, ICD-10-CM, Medicaid coding guidelines, and reimbursement methods.

• Adjust to evolving regulations, priorities, and audit expectations while ensuring accuracy and quality.

• Travel occasionally within Indiana.

⛳️ Requirements

• Possession of a current coding certification such as CCS, CPC, CPMA, or an equivalent credential.

• At least one (1) year of experience in medical coding, coding audits, billing compliance, claims assessment, healthcare reimbursement, or related auditing functions.

• Strong expertise in Microsoft Excel, including data analysis, sorting/filtering, formula usage, data validation, reporting, and handling large datasets.

• Excellent analytical thinking, problem-solving abilities, and technical writing skills.

• Capability to work autonomously while juggling multiple priorities in a fast-paced setting.

• Ability to regularly communicate, sit, and utilize technology tools such as a laptop for extended durations.

• Proficient close vision and the ability to adjust focus as needed.

🏝️ Benefits

• Make a significant impact on healthcare programs that benefit Hoosiers.

• Collaborate with seasoned healthcare, compliance, and auditing professionals.

• Engage continuously with evolving coding standards, regulations, and industry best practices.