Medical Record Audit Specialist

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

📋 Description

• Analyze medical records and associated documentation to evaluate coding precision and adherence to Indiana Health Coverage Programs, CMS, AMA, and other relevant standards and regulations.

• Perform coding and documentation evaluations autonomously and present initial findings to the Lead Reviewer.

• Detect potential coding inconsistencies, documentation gaps, and billing compliance concerns.

• Keep thorough work-papers that outline the procedures conducted, records assessed, findings noted, and conclusions drawn.

• Provide assistance with audit responses and appeals as necessary.

• Ensure that all tasks comply with state, federal, and national coding and reimbursement directives.

• Remain updated on CPT, HCPCS, ICD-10-CM, and Medicaid coding standards, policies, and regulatory changes.

• Investigate Indiana Medicaid regulations and maintain internal collections of bulletins, policies, and procedures.

• Adjust to evolving priorities, policies, regulatory changes, and review requirements while preserving accuracy and meeting deadlines.

• Contribute to a state Medicaid program initiative focused on auditing medical records and claims.

⛳️ Requirements

• Valid coding certification: CCS (AHIMA), CPC (AAPC), or CPMA (AAPC).

• At least 2-3 years of direct experience in medical coding, claims review, or auditing.

• Extensive experience in coding Behavioral Health, Mental Health, or Psychiatric encounters.

• Proficient in ICD-10-CM, CPT, and HCPCS coding systems.

• Experience in conducting medical record audits, claims reviews, or supporting appeals processes.

• Able to complete a timed Excel proficiency assessment covering skills such as sorting, filtering, VLOOKUP, and conditional formatting, as required by the client before submission.

• Familiarity with Indiana Medicaid (IHCP) policies and payer guidelines is preferred.

• Understanding of CMS regulations and AHIMA Standards of Ethical Coding is preferred.

• Experience with Epic, Cerner, 3M Encoder, or similar EHR and encoder systems is preferred.

• Prior experience specifically in Medicaid audit or compliance functions is preferred.

🏝️ Benefits

• Occasional travel to Downtown Indianapolis, IN with expenses covered.