Professional Coder, Special Investigations
3 weeks ago
About the Job:
This part-time position is a key component of our healthcare compliance audit team. As a Healthcare Compliance Auditor, you will be responsible for ensuring the accuracy of medical claims by conducting comprehensive reviews of medical records.
Responsibilities:
- Conduct thorough medical record reviews to verify billing consistency.
- Develop detailed reports summarizing medical record review findings.
- Communicate results to relevant parties, including investigators, Medicaid leadership, law enforcement, legal counsel, healthcare providers, and state regulators.
- Collaborate with Medical Directors to validate audit outcomes.
- Research and analyze coding queries, state regulations, and federal policies.
- Identify potential billing discrepancies, abuse, and fraud.
- Highlight potential cost-saving opportunities resulting from prepayment review.
- Occasional travel required for meetings and potential testimony.
Qualifications:
- Certified Professional Coder (CPC) certification from the American Academy of Professional Coders (AAPC).
- At least 3 years of experience in medical coding or documentation auditing.
- In-depth understanding of standard industry coding guides and guidelines (CPT, HCPCS, ICD-10, CMS 1500, and UB04 data elements).
- Familiarity with coding, state regulations, and policy research.
- Proficiency in Microsoft Excel.
- Strong analytical and critical thinking skills.
Compensation Package:
We offer a competitive compensation package, including a salary range of $43,888.00 - $102,081.60, along with additional benefits such as medical, dental, and vision coverage, and an Employee Stock Purchase Plan for eligible employees.
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