Healthcare Claims Data Auditor (Remote)

Codoxo; United States; Hybrid; USD 85,000 - 125,000; Full time

Benefits offered by this job

Health insurance

Unlimited PTO

Professional development stipend

Home office stipend

401K match

Job summary

Codoxo, a healthcare AI company, is seeking a Data Mining Auditor to perform medical claim audits, review billing and coding policies, provider contracts, and state/federal regulations. Audits include verification of claims data and review of clinical and claims documents to make final determinations.

This role requires a motivated problem solver with strong analytical ability and 4+ years in healthcare provider billing and coding audits.

Qualifications

• Active coding certification from AAPC or AHIMA is required.
• 4+ years of work experience with a focus on healthcare provider billing and coding audits.
• Advanced knowledge of CPT-4, HCPCS, and ICD-10-CM coding systems, guidelines, and regulatory requirements.
• Knowledge of Medicare, Medicaid and Commercial reimbursement methodologies.
• Familiarity with payer claims processing systems is desirable.

Responsibilities

• Perform medical claim audits by reviewing customer claims data and charges, and/or medical records, to ensure compliance with coding guidelines and customer requirements.
• Draft clear, defensible audit rationales and findings documentation for client review and workflow.
• Collaborate with analytics and AI teams to translate clinical, coding, and regulatory requirements into audit concepts and deterministic review logic.
• Maintain high quality, accuracy, and productivity; keep current on coding guidelines.
• Prioritize assignments to meet goals and deadlines.

Skills

Analytical ability

Organizational skills

Communication skills

Team collaboration

Education

Active coding certification (AAPC/AHIMA)

Tools

SQL

Python

Microsoft Office

JIRA

SharePoint

AWS

Job description

Codoxo, a healthcare AI company, is seeking a Data Mining Auditor to perform medical claim audits, review billing and coding policies, provider contracts, and state/federal regulations. Audits include verification of claims data and review of clinical and claims documents to make final determinations.

This role requires a motivated problem solver with strong analytical ability and 4+ years in healthcare provider billing and coding audits.