Medical Coding Auditor I

Healthcare Management Administrators•Washington, DC

3d•$30 - $36•Hybrid

About The Position

The Medical Claims Coding Auditor and Itemized Bill Reviewer plays a critical role in ensuring the accuracy, compliance, and cost-effectiveness of medical claims. This position is responsible for auditing medical records and itemized bills to validate coding accuracy, identify billing discrepancies, and support cost containment strategies. The ideal candidate has a strong background in medical coding, billing practices, and regulatory compliance, with a keen eye for detail and a commitment to integrity.

Requirements

High School Diploma Required
Certified Professional Coder (CPC), Certified Coding Specialist (CCS), or equivalent required.
1-3 years of health plan experience
1+ years of medical claims auditing, coding, or billing
Familiarity with payer policies, CMS regulations, and medical necessity guidelines.
Excellent analytical, organizational, and communication skills.
Proficiency in claims systems, EMRs, and Microsoft Office Suite.
Strong problem-solving and critical thinking skills
Motivated self-starter with the ability to work independently
Enjoys the pace and rhythm of a deadline-oriented environment requiring strong prioritization skills

Responsibilities

Conduct detailed audits of medical claims and itemized bills to ensure accuracy and compliance with coding standards (ICD-10, CPT, HCPCS).
Identify and document billing errors, upcoding, unbundling, and other discrepancies.
Review high-dollar claims and complex cases for potential overcharges or inappropriate billing.
Validate diagnosis and procedure codes against medical documentation.
Ensure coding aligns with payer policies, CMS guidelines, and industry best practices.
Support cost containment initiatives by identifying opportunities for claim reductions or denials.
Assist in the development of audit strategies to target high-risk claims.
Stay current with changes in coding regulations, payer guidelines, and healthcare laws.
Participate in internal quality assurance programs to ensure audit consistency and accuracy.
Provide feedback and training to internal teams on coding and billing best practices.