[Hiring] Coding Auditor @Healthcare Fraud Shield

Role Description

The Coding Auditor is a professional auditing role designed for a certified professional coder. Under direct supervision of Healthcare Fraud Shield SIU management, this position executes routine coding reviews to ensure health records align accurately with billed ICD-10-CM, CPT, HCPCS, Revenue codes. The ideal candidate has a strong foundation in primary medical coding and a keen eye for detail, eager to learn complex audit frameworks, regulatory policies, and documentation validation.

• Compare the procedures and codes billed on a claim to a medical record.
• Compare information submitted on the claims in order to determine amount and nature of billable services as needed.
• Determines appropriateness of billing and reimbursement as needed.
• Documents findings for each claim line in a spreadsheet as needed.
• Summarize findings in a written report as needed.
• Abstracts CPT, HCPCS, Revenue Codes, DRG codes, and ICD-10 from medical records as needed.
• Responsible for maintaining current knowledge of coding guidelines and relevant federal and/or state regulations as needed.
• Understands and complies with all company Privacy and Security standards.
• Employee may not use or disclose any protected health information, except as otherwise permitted, or required, by law.
• On average, there are a minimum of 5-10 claim line reviews per hour.
• Other duties as needed.

Qualifications

• Knowledge of medical terminology.
• Knowledge of coding including CPT, HCPCS, Revenue Codes, DRG Codes, and ICD-10.
• Knowledge of specialty medical practices.
• Must be detail oriented.
• Ability to communicate effectively both verbally and in writing.
• Strong listening skills.
• Independent.
• Responsible.
• Self-disciplined.
• Ability to meet defined performance and production goals.
• Strong computer skills.
• This job requires access to confidential and sensitive information, requiring ongoing discretion and secure information management.

Requirements

• Minimum of one year of investigative experience is required.
• Required to have one of the following: CPC, CCS, CCA.

Benefits

• Medical, Dental & Vision insurance.
• 401(k) retirement savings with employer match.
• Vacation and sick paid time off.
• 7 paid holidays & 2 floating holidays.
• Paid maternity/paternity leave.
• Disability & Life insurance.
• Flexible Spending Account (FSA).
• Employee Assistance Program (EAP).
• Professional and career development initiatives.
• Remote work eligible.

Remote Work Requirements

• Must have high speed Internet (satellite is not allowed for this role) with a minimum speed of 25mbs download and 5mbs upload.