Certified Medical Coding Auditor

TL;DR

Certified Medical Coding Auditor: Review medical bills to identify billing, coding errors, and savings opportunities with an accent on claim discrepancies, unbundled charges, and regulatory compliance. Focus on analyzing complex claims, resolving disputes through negotiation, mentoring junior analysts, and contributing to process improvements.

Location: Fully remote, must be US based to comply with company policies such as HIPAA.

Company

Platform simplifying healthcare for employers, payers, providers, and members to reduce costs, improve quality, and elevate the experience.

What you will do

• Review medical bills for appropriate billing, coding, and savings opportunities.
• Analyze and resolve complex claim discrepancies.
• Collaborate with Negotiation team on issue resolution and additional savings.
• Communicate findings via Bill Review Reports and handle client inquiries.
• Evaluate bill reconsideration requests and escalated provider disputes.
• Mentor junior analysts and support training on codes and procedures.

Requirements

• 3+ years of auditing, claims review, and/or billing experience in healthcare.
• CPC and/or CIC certification.
• Working knowledge of ICD-10, CPT, HCPCS, Revenue codes, and CMS guidelines.
• Excellent verbal and written communication skills.
• Must be US based with quiet workspace, reliable internet, and adherence to security protocols including VPN.
• Ensure compliance with HIPAA and regulatory standards.

Nice to have

• Experience in DRG validation.
• Knowledge of Health Insurance, Medicare guidelines, and healthcare programs.
• RevCycle Pro, Encoder Pro, or SuperCoder software experience.

Culture & Benefits

• Generously subsidized Medical, Dental, Vision insurance via own products.
• HSA, FSA, DCFSA spending accounts; 401K with match and immediate vesting.
• Generous PTO including vacation, sick leave, holidays; paid maternity/paternity leave.
• Flexible remote work environment with provided equipment.
• Employee Assistance Program, pet insurance, discounts, and community giveback PTO.