Outpatient Coder Auditor (Healthcare)

TL;DR

Outpatient Coder Auditor (Healthcare): Reviewing outpatient medical claims to ensure coding accuracy and compliance with CMS and payer guidelines with an accent on payment integrity and cost savings. Focus on performing detailed coding audits, identifying billing inaccuracies, and developing audit strategies for outpatient facility claims.

Location: Remote (US)

Salary: $100,000 - $102,500

Company

hirify.global is a leading authority in payment integrity solutions dedicated to bringing accuracy, accountability, and clinical excellence to healthcare.

What you will do

• Perform detailed coding audits on outpatient facility claims to validate CPT/HCPCS, revenue codes, modifiers, and ICD-10 coding.
• Evaluate medical record documentation to ensure services are coded, billed, and reimbursed accurately.
• Identify and analyze payment integrity issues including overpayments, underpayments, and incorrect billing patterns.
• Collaborate with clinical and data analytics teams to develop new outpatient claim review concepts and audit strategies.
• Research and apply current CMS OPPS, APC, and EAPG guidelines to ensure compliant auditing practices.
• Contribute to the development and testing of automated audit tools and rule logic.

Requirements

• Certified Professional Coder (CPC), Certified Outpatient Coder (COC), or equivalent AHIMA certification (CCS).
• 3+ years of experience in outpatient facility coding, auditing, or payment integrity.
• Strong knowledge of CMS OPPS, APC, and EAPG payment methodologies.
• Proficiency in interpreting medical documentation and applying official coding guidelines.
• Must have a dedicated workspace with minimal interruptions to protect PHI and HIPAA information.
• Must be based in the US (implied by 401k, FSA and CMS requirements).

Nice to have

• Experience with managed care organizations, commercial payer claim reviews, or payment integrity programs.
• Familiarity with data analytics tools and claim review platforms.
• Prior experience in audit development.

Culture & Benefits

• Comprehensive medical, dental, and vision plan options.
• 401(k) with employer match.
• Generous paid time off, including accrued PTO from day one and holiday leave.
• Wellness perks including Commuter Benefits and FSAs.
• Investment in professional growth through mentorship and LinkedIn Learning.