Analyst, Healthcare Medical Coding - Disputes, Claims & Investigations

Stout • Arlington, MD

3d

About The Position

This role contributes to complex healthcare consulting engagements involving coding audits, disputes, claims analysis, and investigations. The analyst will deliver high-quality, accurate coding analysis to inform client decisions, regulatory responses, and litigation support. Key aspects include identifying risks related to billing, coding, and reimbursement, including potential fraud, waste, and abuse, and supporting the development of defensible findings and recommendations through detailed documentation and analysis. The position requires enhancing Stout’s reputation for excellence by applying deep expertise in inpatient coding, reimbursement systems, and compliance.

Requirements

• Bachelor’s degree in Health Information Management or related field (or equivalent experience).
• Minimum of five (5) years of recent acute-care inpatient facility coding experience.
• Strong experience with DRG and PCS coding, including auditing; denials experience preferred.
• Active coding credential required (CCS, CIC, RHIT, or RHIA).
• Knowledge of MS-DRG, APR-DRG, APC methodologies and reimbursement frameworks.
• Experience reviewing clinical documentation for accuracy, compliance, and reimbursement optimization.
• Familiarity with healthcare regulatory frameworks (e.g., CMS, HIPAA, False Claims Act).
• Proficiency in Microsoft Office (Excel, Word, PowerPoint); experience with data visualization tools is a plus.
• Strong analytical, problem-solving, and written/verbal communication skills.

Nice To Haves

• Denials experience preferred.
• Experience with data visualization tools is a plus.

Responsibilities

• Perform detailed reviews of inpatient medical records to assess accuracy of ICD-10-CM/PCS coding and alignment with clinical documentation.
• Analyze coding, billing, and reimbursement practices across engagements involving audits, disputes, and investigations.
• Support forensic analyses to identify compliance risks, inefficiencies, and reimbursement discrepancies.
• Assist in audits, regulatory reviews, and litigation support by gathering evidence, analyzing issues, and contributing to reporting.
• Evaluate DRG/APR-DRG/APC assignments and reimbursement implications based on clinical documentation.
• Collaborate with internal teams, clients, and legal counsel to support engagement objectives.
• Prepare clear, well-structured reports, analyses, and client-ready deliverables summarizing findings and recommendations.
• Monitor coding trends, denials, billing edits, and regulatory updates to inform analyses and engagement insights.
• Contribute to internal knowledge sharing and continuous improvement within the Healthcare Consulting practice.

Benefits

• Competitive compensation
• Benefits and wellness options tailored to support employees at every stage of life
• Flexible work schedules
• Discretionary time off policy
• Annual bonus plan

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level