Certified Professional Coder & Medical Audit Specialist

Jobtailor; Alabama; On-site; USD 65,000 - 90,000; Full time

Job summary

Jobtailor is seeking an experienced Medical Coding Auditor to conduct comprehensive medical record reviews and ensure billing accuracy. You will craft detailed written summaries and present findings to investigators, leadership, counsel, providers, and regulators.

Role requires reviewing cases with Medical Directors, researching coding policies, and potentially testifying. Travel for meetings is expected, and strong Excel skills are essential.

Qualifications

• AAPC Coding certification is required (CPC).
• 3+ years of experience in medical coding or documentation auditing.
• Strong knowledge of CPT, HCPCS, Revenue Codes, CMS 1500 and UB04 data elements.
• Experience researching coding, state regulations and policies.
• Proficiency with Microsoft Excel.

Responsibilities

• Conduct comprehensive medical record reviews to ensure billing aligns with medical records.
• Provide detailed written summaries of medical record review findings.
• Articulate findings to investigators, Medicaid plan leadership, law enforcement, legal counsel, providers and state regulators.
• Review and discuss cases with Medical Directors to validate decisions.
• Assist with investigative research related to coding questions, state and federal policies.
• Identify potential billing errors, abuse and fraud.
• Identify opportunities for savings related to potential prepayment review cases.
• Maintain appropriate records, files and documentation.
• Travel for meetings and potentially testify.

Skills

Medical Record Review

Billing Consistency Analysis

Documentation Auditing

Investigative Research

Communication Skills

Detail Orientation

Analytical Thinking

Education

GED or equivalent

Certified Professional Coder (CPC)

Tools

Microsoft Excel

Job description

Jobtailor is seeking an experienced Medical Coding Auditor to conduct comprehensive medical record reviews and ensure billing accuracy. You will craft detailed written summaries and present findings to investigators, leadership, counsel, providers, and regulators.

Role requires reviewing cases with Medical Directors, researching coding policies, and potentially testifying. Travel for meetings is expected, and strong Excel skills are essential.