Nurse Coder Auditor – HBA

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

📋 Description

• Verify the precision of CPT, HCPCS, revenue codes, and billed line-item charges on both outpatient and inpatient facility claims.

• Examine medical records and accompanying documentation to ensure that billed services, supplies, and items are properly documented and billed correctly.

• Utilize CMS guidelines, coding protocols, MUE/NCCI edits, industry standards, and policies during the claim review process.

• Conduct itemized bill assessments, including the validation of revenue code line items and related documentation.

• Perform audits on hospital bills to analyze billed line charges and detect potential issues related to coding, billing, or documentation.

• Evaluate medical necessity as part of the claim review process.

• Draft appeal responses in accordance with relevant coding guidelines, industry standards, and company/client policies.

• Support the development of new concepts and criteria for claim selection.

⛳️ Requirements

• Current coding certification in good standing, such as CCS, CPC, COC, RHIT, or RHIA.

• In-depth understanding of CPT, HCPCS, ICD-10, revenue codes, CMS, and coding guidelines.

• Familiarity with inpatient coding and billing guidelines, hospital bill audits, itemized bill assessments, and line-level claim reviews.

• Capability to analyze and interpret complex medical documentation.

• Background in coding validation, auditing, or claims review.

• Excellent verbal and written communication skills.

• Ability to effectively prioritize tasks and manage multiple review activities.

• Proficiency in Microsoft Office, particularly Excel.

🏝️ Benefits

• Competitive salaries

• Highly valued health insurance

• 401(k) plan with employer match

• Paid parental leave