Coding Auditor, Senior Associate

Gainwell Technologies LLC•Any city, OH

68d•$50,500 - $72,200•Remote

About The Position

The Coding Auditor, Senior Associate performs coding reviews of medical records and other documentation to determine correct coding according to the review methodology applicable to the contract. The role uses proprietary auditing systems to review records, document findings, and support determinations with policy and regulatory guidance. The position requires substantial experience in facility-based inpatient coding and/or outpatient coding edits, along with a strong understanding of reimbursement guidelines and MS-DRG, AP-DRG, APR-DRG, ASC, and APC payment systems. This is a remote, work-from-home position within the United States.

Requirements

At least one year of active professional credentials through AHIMA or AAPC, such as CPC, CCS, COC, RHIA, or RHIT.
At least three years of coding inpatient or outpatient claims.
Proficiency in medical record auditing and ICD-10-CM, ICD-10-PCS, APC, ASC, HCPCS, and CPT coding methodology.
Thorough understanding of APR-DRG, AP-DRG, and MS-DRG.
Demonstrated experience in medical record coding and auditing.

Responsibilities

Audit medical record documentation to determine the accuracy of principal and secondary diagnosis codes, including MCC and CC, and procedure codes.
Follow official coding guidelines, coding clinics, and regulatory guidelines and mandates, using advanced ICD-10 expertise to substantiate conclusions.
Use proprietary auditing systems to document audit determinations and rationale.
Meet productivity and quality performance standards established by management.
Cross-train to review multiple claim types to support client needs.
Assist management in training new Coding Auditors through monitoring, mentoring, feedback, and education.
Maintain current knowledge of coding guidelines and complete required continuing education units to maintain coding certification.
Attend training and scheduled meetings to enhance skills and knowledge of clinical policies, procedures, rules, and regulations.