Medical Coding Auditor / Coding Validation Reviewer

Aptive•Remote,

12d•$25 - $30•Remote

About The Position

Aptive Resources is seeking experienced coding auditors to conduct external coding audits for Veterans Affairs medical centers in Georgia, Alabama, and South Carolina. The role involves auditing inpatient DRG, outpatient, and professional fee coding, reporting findings, and providing training to VA coding staff and clinicians to improve accuracy and compliance. The VA anticipates auditing approximately 5,000 records annually across facilities in Atlanta, Birmingham, Columbia, and Augusta.

Requirements

An active RHIA, RHIT, CCS, CCS-P, CPC, or CPC-H credential.
At least 3 years of experience as a consultant reviewing records for large tertiary care hospitals and outpatient organizations covering all subspecialties and primary care.
At least 3 years of education and training experience, such as teaching coders or providers.
At least 3 years of coding experience.
Two current client references who can speak to your audit work (submitted with contract proposal).
Proof of active credentials and a current resume for the proposal.
Completion of an accredited coding, HIM, or health information technician program.
Expertise in ICD-10-CM/PCS, CPT, HCPCS, DRG/MS-DRG, APC, E/M, and NCCI edits.
US citizenship.
Ability to pass a federal background investigation (NACI) and fingerprinting.

Nice To Haves

An auditing credential such as CDIP, CPMA, or CIC, in addition to a required credential.
Experience auditing for the VA or another federal health system.
Strong report writing and presentation skills, including explaining findings in plain language for non-coders.

Responsibilities

Audit coded data for accuracy and compliance, separate from regular coding work, focusing on inpatient facility (DRG), outpatient facility, inpatient professional services (including surgery), or outpatient services (urgent care, clinic visits, ambulatory surgery).
Review up to the first 25 diagnoses and 25 procedures on each record for both facility and professional services.
Assist in building statistically valid samples (95% confidence level, at least 10% of records) and data collection tools for each audit.
Review each facility's HIMS policies and coding procedures prior to the audit.
Classify errors as coding, diagnosis, modifier, documentation, or compliance errors, providing coding references to support each classification.
Write facility audit reports detailing accuracy, financial impact, and areas of concern, and contribute to a network-wide report.
Discuss draft findings with the HIMS Chief, COR, and facility leaders within 7 business days of the audit.
Deliver final reports within 15 business days of the audit.
Create facility-specific training plans.
Lead "train the trainer" education sessions of at least 2 hours, utilizing real charts, for coding staff, managers, and physicians.
Conduct exit conferences with Health Information Management leadership.