Facility Coding Auditor & Claim Review Specialist

Sustainable World, Inc.; Northern (KY); Hybrid; USD 90,000 - 120,000; Full time

Benefits offered by this job

Medical, Dental, Vision coverage

401K with company match

Certification and Tuition Reimburs e

Job summary

Sustainable World, Inc. is seeking a remote Health Information Management Auditor to support the Director of HIM by conducting comprehensive audits of hospital outpatient and ProFee claims, evaluating coding accuracy, and identifying revenue integrity improvements.

Using proprietary software, you will develop client reports, present findings to leadership, and help create educational materials on coding and billing best practices, while collaborating with consultants and clients.

Qualifications

• AHIMA or AAPC certification required (CPC-A not accepted).
• Minimum 5 years of hospital outpatient facility coding audit experience.
• Advanced knowledge of ED, SDS, OBS, I&I, E/M and ancillary outpatient services.
• Experience presenting findings to healthcare clients and leadership.
• Strong understanding of revenue cycle processes, billing principles and coding compliance.
• Excellent written and verbal communication skills.

Responsibilities

• Perform detailed audits of hospital outpatient and ProFee claims to identify opportunities.
• Review and recommend coding, charge capture, revenue integrity and claim optimization strategies.
• Utilize proprietary software to analyze audit findings and develop client reports.
• Present audit results and recommendations to clients clearly and professionally.
• Respond to coding and compliance inquiries with concise written and verbal communication.
• Collaborate with revenue cycle consultants, coding professionals, and client stakeholders.
• Develop educational materials, FAQs, and client-facing guidance on coding and billing best practices.
• Assist with special projects and other duties as assigned.

Skills

CPC/AHIMA or AAPC cert

5+ years hospital outpatient coding

ED coding

SDS coding

OBS coding

I&I coding

E/M coding

Ancillary outpatient services

Job description

JOB SUMMARY:

Support the Director of Health Information Management (HIM) by conducting comprehensive claim audits and reviewing hospital outpatient and professional fee (ProFee) claims for coding accuracy, revenue integrity, and billing compliance. Utilizing proprietary software, this role evaluates coding opportunities, identifies revenue cycle improvement recommendations, and assists clients in optimizing claim quality and reimbursement outcomes.

This is a remote position

Key Responsibilities

• Perform detailed audits of hospital outpatient and ProFee claims to identify coding, billing, charging, and revenue cycle improvement opportunities.
• Review and recommend coding, charge capture, revenue integrity, and claim optimization strategies.
• Utilize proprietary software to analyze audit findings and develop standardized client reports.
• Present audit results and recommendations to clients in a clear, professional manner.
• Respond to coding and compliance-related inquiries with concise, grammatically correct written and verbal communication.
• Collaborate with revenue cycle consultants, coding professionals, and client stakeholders to support project goals.
• Develop educational materials, FAQs, and client-facing guidance on coding and billing best practices.
• Assist with special projects and other duties as assigned.

QualificationsRequired

• AHIMA or AAPC coding certification required (CPC-A not accepted).
• Minimum 5 years of hospital outpatient facility coding audit experience.
• Advanced knowledge of:
  • Emergency Department (ED)
  • Same Day Surgery (SDS)
  • Observation (OBS)
  • Injection & Infusion (I&I)
  • Facility Evaluation & Management (E/M)
  • Ancillary outpatient services
• Experience presenting findings to healthcare clients and leadership teams.
• Strong understanding of revenue cycle processes, billing principles, and coding compliance.
• Excellent written and verbal communication skills.
• Proficiency interpreting audit findings and presenting recommendations to clients.

Preferred

• Inpatient facility coding experience.
• Critical Access Hospital (CAH) coding experience.
• Revenue integrity, compliance experience

We Offer:

• Quality of life with a remote predictable, full-time schedule
• Competitive Salary commensurate to experience
• Medical, Dental, Vision coverage and more
• Long-term disability insurance, and life insurance
• Ample parental leave
• 401K with company match
• Certification and Tuition Reimbursement
• Holidays, Flexible Time Off

PHYSICAL DEMANDS:

Note: Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions as described. Regular eye-hand coordination and manual dexterity is required to operate office equipment. The ability to perform work at a computer terminal for 6-8 hours a day and function in an environment with constant interruptions is required. At times, Team Members are subject to sitting for prolonged periods. Infrequently, Team Member must be able to lift and move material weighing up to 20 lbs. Team Member may experience elevated levels of stress during periods of increased activity and with work entailing multiple deadlines.

A job description is only intended as a guideline and is only part of the Team Member’s function. The company has reviewed this job description to ensure that the essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate.