Coding Auditor

Hcfraudshield; Chesterfield (MO); On-site; USD 60,000 - 90,000; Full time

Benefits offered by this job

Medical, Dental & Vision insurance

401(k) retirement savings with company

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

Remote work eligible

Job summary

Healthcare Fraud Shield is seeking a Coding Auditor to perform routine coding reviews and ensure medical records align with billed codes. The role requires strong coding knowledge and meticulous attention to accuracy, with supervision by SIU management.

The ideal candidate will review claims, abstract codes, and prepare written summaries while maintaining up-to-date knowledge of coding guidelines and privacy standards. The position emphasizes quality, accuracy, and adherence to regulations.

Qualifications

• Must have CPC/CCS/CCA certification.
• At least one year of investigative experience.
• Strong foundation in medical coding and auditing practices.
• Ability to interpret ICD-10-CM, CPT, HCPCS, DRG codes.

Responsibilities

• Review procedures and codes billed on claims against medical records.
• Assess billable services and determine appropriate reimbursement.
• Document findings for each claim line and summarize in written reports.
• Abstract CPT, HCPCS, Revenue Codes, DRG codes, and ICD-10 from records.
• Maintain current knowledge of coding guidelines and regulatory requirements.
• Uphold privacy and security standards for all protected information.

Skills

Medical terminology

Medical coding knowledge (CPT, HCPCS,

Education

CPC

CCS

CCA

Job description

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.