Coding Auditor

Healthcare Fraud Shield•Chesterfield, MO

1d•Remote

About The Position

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.

Requirements

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.
Minimum of one year of investigative experience is required.
Required to have one of the following: CPC, CCS, CCA
Must have high speed Internet (satellite is not allowed for this role) with a minimum speed of 25mbs download and 5mbs upload.

Responsibilities

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.