Medical Coding Auditor / Coding Validation Reviewer

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

📋 Description

• Conduct external coding audits for Veterans Affairs medical facilities in Georgia, Alabama, and South Carolina.

• Evaluate inpatient DRG, outpatient, and professional fee coding for precision and adherence to regulations.

• Examine up to the first 25 diagnoses and first 25 procedures on each record for both facility and professional services.

• Assist in creating statistically valid samples with a 95% confidence level and a minimum of 10% of records.

• Design data collection tools tailored for each audit.

• Assess the HIMS policies and coding procedures of each facility prior to audits.

• Identify coding, diagnosis, modifier, documentation, and compliance errors, substantiating each with coding references.

• Prepare facility audit reports detailing accuracy, financial implications, and areas needing attention.

• Contribute insights to a network-wide report.

• Discuss draft findings with the HIMS Chief, COR, and facility leaders within 7 business days post-audit.

• Submit final reports within 15 business days.

• Develop facility-specific training programs.

• Facilitate a minimum of 2-hour train-the-trainer sessions using actual charts for coding staff, managers, and physicians.

• Hold exit conferences with Health Information Management leadership.

• Travel to VA facilities only when authorized by the government.

⛳️ Requirements

• Valid RHIA, RHIT, CCS, CCS-P, CPC, or CPC-H credential.

• A minimum of 3 years of consulting experience reviewing records for large tertiary care hospitals and outpatient organizations across all subspecialties and primary care.

• At least 3 years of experience in education and training, such as instructing coders or providers.

• Minimum of 3 years of coding experience.

• Two current client references who can attest to audit work.

• Documentation of active credentials and a current resume for the contract proposal.

• Completion of an accredited coding, HIM, or health information technician program.

• Proficient in ICD-10-CM/PCS, CPT, HCPCS, DRG/MS-DRG, APC, E/M, and NCCI edits.

• Must be a US citizen.

• Capability to pass a federal background investigation (NACI) and fingerprinting.

• Completion of the VA's annual Privacy and Information Security Awareness and HIPAA training (TMS 10176 and 10203).

• Preferred: auditing credentials such as CDIP, CPMA, or CIC.

• Preferred: experience in auditing for the VA or another federal health system.

• Preferred: strong report writing and presentation abilities, including the capacity to articulate findings in straightforward language for non-coders.

🏝️ Benefits

• 100% remote work opportunity within the US.

• Reimbursement for approved travel in accordance with federal travel regulations.

• Annual training on Privacy and Information Security Awareness and HIPAA.

• Commitment to equal opportunity employment.

• Veterans, Reserve and National Guard members, and transitioning active-duty service members are strongly encouraged to apply.