[Hiring] Inpatient and Facility Coding Auditor - Claims Review Specialist @CorroHealth

Role Description

The Claim Review Specialist serves as a revenue cycle and coding consultant, partnering with the Director of HIM to perform complex concurrent and retrospective audits of hospital inpatient, facility and outpatient claims. This role evaluates coding accuracy and documentation compliance by validating ICD-10, CPT, and HCPCS code assignments in accordance with CMS, AHIMA, AHA Coding Clinic, and official coding guidelines. Using proprietary software, the specialist analyzes claim and coding data, identifies opportunities for coding, billing, and revenue cycle improvement, develops standardized reports, and communicates audit findings to clients. The position also provides coding education, answers client questions, prepares written guidance and FAQs, supports client meetings, and collaborates with the revenue cycle consulting team to drive compliance, operational excellence, and reimbursement optimization.

Essential Duties and Responsibilities

• Analyze findings and identify potential root causes of produced errors.
• Prepare summary reports of findings to clients, supplying specific references supporting findings contained within the provided audit report.
• Provide second-level review of processes to ensure compliance with legal and procedural policies and to ensure appropriate code assignments.
• Research, analyze, and respond to inquiries regarding compliance, coding, and denials while protecting patient health and client information.
• Function as a member of the Consulting Services Team which develops and provides coding education to clients.
• Conduct audits as assigned, meeting the productivity standards set by record type for each audit.
• Prepare deliverables for the client as required for the audit scope while meeting timelines.
• Conduct independent QA of assigned audit results prior to final submission for QA review and approval, with a minimum accuracy expectation of 95%.
• Report work time and work products in a timely and accurate manner.
• Communicate with coworkers in an open and respectful manner that promotes teamwork and knowledge sharing.
• Interact with clients in a professional manner that exhibits excellent relationships, work performance, and communication skills.
• Provide a schedule of planned work activities, events, and sites, and any changes to Management and appropriate staff.
• Maintain professional credentials and knowledge of coding, reimbursement, and compliance issues through continuing education.
• Periodic travel, as applicable.
• Other duties and responsibilities, as assigned.

Qualifications

• Active AHIMA or AAPC credential required; CCS, CPC or RHIT required.
• Minimum of five (5) years of coding and/or auditing experience in an acute care hospital or healthcare consulting environment, including inpatient and facility services.
• Strong knowledge of ICD-10-CM/PCS, CPT, HCPCS, reimbursement methodologies, regulatory compliance, and audit best practices.
• Proficiency with electronic health record (EHR) systems, such as Epic, Cerner/PowerChart, Meditech, and other healthcare applications.
• Advanced analytical, critical-thinking, and problem-solving skills with the ability to interpret complex clinical, coding, and regulatory information.
• Strong computer skills, including proficiency in Microsoft Office applications and auditing/reporting software.
• Excellent written and verbal communication skills with the ability to present findings and provide clear, client-focused guidance to both operational and executive audiences.
• Demonstrated ability to manage multiple projects, client engagements, and priorities while working independently with minimal supervision.
• Highly organized with strong attention to detail, accuracy, and commitment to ethical coding and auditing practices.
• Experience working remotely and collaborating effectively within a team-oriented, consulting-focused environment.
• Ability to work successfully with multiple clients, diverse stakeholders, and cross-functional teams while maintaining productivity and quality standards.

Benefits

• Quality of life with a remote predictable, full-time schedule.
• Competitive Salary commensurate to experience.
• Medical, Dental, Vision coverage and more.
• Long-term disability insurance, and life insurance.
• Ample parental leave.
• 401K with company match.
• Certification and Tuition Reimbursement.
• Holidays, Flexible Time Off.

Physical Demands

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions as described. Regular eye-hand coordination and manual dexterity is required to operate office equipment. The ability to perform work at a computer terminal for 6-8 hours a day and function in an environment with constant interruptions is required. At times, Team Members are subject to sitting for prolonged periods. Infrequently, Team Member must be able to lift and move material weighing up to 20 lbs. Team Member may experience elevated levels of stress during periods of increased activity and with work entailing multiple deadlines.