Coding Auditor (AI)

TL;DR

Coding Auditor (AI): Performing detailed claims payment quality reviews and coding compliance audits with an accent on ensuring appropriate reimbursement and regulatory adherence. Focus on providing educational feedback to facilities and leveraging Enterprise-AI tools to uncover improvement opportunities and drive operational efficiencies.

Location: Must reside in Tennessee or contiguous counties. Role is remote with potential for rare travel to facilities.

Company

A major health insurance provider dedicated to quality healthcare and compliance.

What you will do

• Review claims materials and medical records to assess the accuracy of provider-submitted claims.
• Communicate audit results to stakeholders and recommend corrective actions.
• Plan and conduct investigations to identify potential subrogation or fraud.
• Document audit findings and support the development of internal policies and procedures.
• Utilize AI-approved tools to analyze data and identify opportunities for process improvement.

Requirements

• Must reside in Tennessee or contiguous counties.
• Bachelor’s degree or 4 years of equivalent corporate experience.
• At least 2 years of facility inpatient/outpatient coding or auditing experience.
• Active AHIMA or AAPC certification (or willingness to obtain CCS within 12 months).
• Solid knowledge of reimbursement methodologies, ICD-10, CPT, and HCPCS.
• Proficiency in Microsoft Office and strong analytical skills.

Culture & Benefits

• Opportunity to work with advanced AI-driven auditing tools.
• Collaborative team environment with independent work responsibilities.
• Focus on professional development and certification support.
• Comprehensive corporate benefits package.