[Hiring] Senior Associate, Coding Auditor @Gainwell Technologies LLC

Role Description

We are seeking a talented individual for an Inpatient Coding Auditor, Senior Associate who is responsible for performing coding reviews of medical records and/or other documentation to determine correct coding as defined by review methodologies specific to the contract for which review services are being provided. This involves accessing proprietary systems to audit medical records, accurately document findings and providing policy/regulatory support for determination. The candidate must have an extensive background in either facility-based inpatient coding and/or outpatient coding edits and has a high level of understanding in reimbursement guidelines specifically an understanding of the MS-DRG, AP-DRG and APR-DRG, ASC and APC payment systems.

• Performs audits of medical record documentation to determine the accuracy of principal and secondary diagnosis (including MCC & CC) and procedure codes.
• Adheres to official coding guidelines, coding clinics and regulatory guidelines and mandates.
• Draws on advanced ICD-10 coding expertise to substantiate conclusions.
• Utilizes HMS proprietary auditing systems with a high level of proficiency to document audit determinations and rationale.
• Consistently achieves productivity and quality performance standards established by management.
• Actively cross-trains to perform reviews of multiple claim types to provide a flexible workforce to meet client needs.
• Assists management with training new Coding Auditors to include daily monitoring, mentoring, feedback and education.
• Maintains current knowledge of coding guidelines and successfully completes required CEUs to maintain coding certification.
• Responsible for attending training and scheduled meetings to enhance skills and working knowledge of clinical policies, procedures, rules, and regulations.

Qualifications

• 1+ years active professional credentials through AHIMA or AAPC: CPC, CCS, COC, RHIA, RHIT; required.
• 3+ years coding inpatient or outpatient claims; required.
• Demonstrated proficiency in medical record auditing and ICD-10 CM, ICD-10-PCS, APC, ASC, HCPCS, and CPT coding methodology.
• Demonstrates a thorough understanding of the APR-DRG, AP-DRG, and MS-DRG.
• Demonstrated experience in medical record coding and auditing.

Benefits

• Remote (work from home) environment within the United States.
• Benefits on first day of employment.
• Clear path to advancement with training and leadership.