Coding Auditor

Healthcare Fraud Shield; Chesterfield (MO); Presencial; USD 55.000 - 85.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Medical insurance

Dental & Vision insurance

401(k) matching

Paid time off

Holidays (7) + floating holidays

Maternity/paternity leave

Disability & Life insurance

FSA

EAP

Descripción de la vacante

Healthcare Fraud Shield is seeking a Coding Auditor, a professional coder who will review medical records and coding accuracy against billed ICD-10-CM, CPT, HCPCS, and Revenue codes. Under SIU leadership, you will perform routine reviews and document findings to support compliant reimbursement.

The role requires strong attention to detail, knowledge of coding guidelines, and strict adherence to privacy and security standards.

Formación

• Knowledge of medical terminology.
• Knowledge of CPT, HCPCS, Revenue Codes, DRG Codes, and ICD-10.
• Knowledge of specialty medical practices.
• Must be detail oriented.
• Ability to communicate effectively both verbally and in writing.
• Strong listening skills.
• Independent.
• Responsible.
• Self-disciplined.
• Ability to meet defined performance and production goals.
• Strong computer skills.
• Access to confidential information requires discretion.

Responsabilidades

• Compare the procedures and codes billed on a claim to a medical record.
• Compare information submitted on the claims in order to determine amount and nature of billable services as needed.
• Determines appropriateness of billing and reimbursement as needed.
• Documents findings for each claim line in a spreadsheet as needed.
• Summarize findings in a written report as needed.
• Abstracts CPT, HCPCS, Revenue Codes, DRG codes, and ICD-10 from medical records as needed.
• Responsible for maintaining current knowledge of coding guidelines and relevant federal and/or state regulations as needed.
• Understands and complies with all company Privacy and Security standards.
• Employee may not use or disclose any protected health information, except as otherwise permitted, or required, by law.
• On average, there are a minimum of 5-10 claim line reviews per hour.
• Other duties as needed.

Conocimientos

Medical terminology

Medical coding (CPT/HCPCS/DRG/ICD-10)

Specialty coding knowledge

Detail oriented

Communication skills

Listening skills

Independence

Self-discipline

Performance goals

Computer literacy

Confidentiality

Educación

Investigation experience

CPC

CCS

CCA

Descripción del empleo

Coding Auditor

Department: SIU

Employment Type: Full Time

Location: Headquarters

Description

The Coding Auditor is a professional auditing role designed for a certified professional coder. Under direct supervision of Healthcare Fraud Shield SIU management, this position executes routine coding reviews to ensure health records align accurately with billed ICD-10-CM, CPT, HCPCS, Revenue codes. The ideal candidate has a strong foundation in primary medical coding and a keen eye for detail, eager to learn complex audit frameworks, regulatory policies, and documentation validation.

Key Responsibilities

• Compare the procedures and codes billed on a claim to a medical record.
• Compare information submitted on the claims in order to determine amount and nature of billable services as needed.
• Determines appropriateness of billing and reimbursement as needed.
• Documents findings for each claim line in a spreadsheet as needed.
• Summarize findings in a written report as needed.
• Abstracts CPT, HCPCS, Revenue Codes, DRG codes, and ICD-10 from medical records as needed.
• Responsible for maintaining current knowledge of coding guidelines and relevant federal and/or state regulations as needed.
• Understands and complies with all company Privacy and Security standards.
• Employee may not use or disclose any protected health information, except as otherwise permitted, or required, by law.
• On average, there are a minimum of 5-10 claim line reviews per hour.
• Other duties as needed.

Skills, Knowledge and Expertise

• Knowledge of medical terminology.
• Knowledge of coding including CPT, HCPCS, Revenue Codes, DRG Codes, and ICD-10.
• Knowledge of specialty medical practices.
• Must be detail oriented.
• Ability to communicate effectively both verbally and in writing.
• Strong listening skills.
• Independent.
• Responsible.
• Self-disciplined.
• Ability to meet defined performance and production goals.
• Strong computer skills.
• This job requires access to confidential and sensitive information, requiring ongoing discretion and secure information management.

Certificate/License:

• Minimum of one year of investigative experience is required.
• Required to have one of the following: CPC, CCS, CCA

Benefits

• Medical, Dental & Vision insurance
• 401(k) retirement savings with employer match
• Vacation and sick paid time off
• 7 paid holidays & 2 floating holidays
• Paid maternity/paternity leave
• Disability & Life insurance
• Flexible Spending Account (FSA)
• Employee Assistance Program (EAP)
• Professional and career development initiatives
• Remote work eligible

REMOTE WORK REQUIREMENTS:

• Must have high speed Internet (satellite is not allowed for this role) with a minimum speed of 25mbs download and 5mbs upload.

Healthcare Fraud Shield is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.