Medical Coding Auditor / Coding Validation Reviewer

Aptive; United States; Remote; USD 34,000 - 41,000; Full time

Benefits offered by this job

Remote work within US

Job summary

Aptive Resources seeks experienced coding auditors to conduct external audits for VA medical centers across the US. You will audit inpatient DRG, outpatient, and professional coding, reporting findings and teaching VA staff how to improve accuracy.

Approximately 5,000 records yearly across facilities in GA, AL, SC are expected. Responsibilities include building valid samples, reviewing policies, classifying errors, and delivering final reports within 15 business days.

Qualifications

• Active RHIA, RHIT, CCS, CCS-P, CPC, or CPC-H credential.
• 3+ years consulting in large tertiary care hospitals and outpatient settings.
• 3+ years of education/training experience and coding experience.
• 2 client references for audit work and a current resume.

Responsibilities

• Audit inpatient facility (DRG), outpatient facility, and inpatient professional services.
• Review up to 25 diagnoses and 25 procedures per record for accuracy.
• Develop sampling plans and data collection tools for audits.
• Prepare training materials and lead sessions for staff and physicians.
• Deliver draft and final audit reports within set timelines.

Skills

Audit quality

Training/teaching

Report writing

Data analysis

Education

RHIA

RHIT

CCS

CCS-P

CPC

CPC-H

Tools

CPT/HCPCS tools

DRG/MS-DRG

NCCI edits

Job description

Job Summary

Job Summary:

Location: 100% remote (US only), supporting VA medical centers in VISN 7 Term: 12-month base period plus four 12-month option periods.Pay:25.00/hr-30.00/hr

About the role

Aptive Resources is looking for experienced coding auditors to run external coding audits for Veterans Affairs medical centers in Georgia, Alabama, and South Carolina. You'll audit inpatient DRG, outpatient, and professional fee coding, report what you find, and teach VA coding staff and clinicians how to improve. The VA expects about 5,000 audited records a year across the Atlanta, Birmingham, Columbia, and Augusta facilities.

Primary Responsibilities

What you'll do

• Audit coded data for accuracy and compliance, separately from the regular coding work. Each audit focuses on one area: inpatient facility (DRG), outpatient facility, inpatient professional services including surgery, or outpatient services (urgent care, clinic visits, and ambulatory surgery).
• Review up to the first 25 diagnoses and the first 25 procedures on each record, for both facility and professional services.
• Help build statistically valid samples (a 95% confidence level, and at least 10% of records) and data collection tools for each audit.
• Review each facility's HIMS policies and coding procedures before the audit starts.
• Classify errors as coding, diagnosis, modifier, documentation, or compliance errors, and back up each one with coding references.
• Write facility audit reports covering accuracy, financial impact, and areas of concern, and contribute to a network-wide report.
• Go over draft findings with the HIMS Chief, COR, and facility leaders within 7 business days of the audit, and deliver final reports within 15 business days.
• Create facility-specific training plans, and lead "train the trainer" education sessions of at least 2 hours, using real charts, for coding staff, managers, and physicians.
• Run exit conferences with Health Information Management leadership.

Minimum Qualifications

Required qualifications

• An active RHIA, RHIT, CCS, CCS-P, CPC, or CPC-H credential.
• At least 3 years of experience as a consultant reviewing records for large tertiary care hospitals and outpatient organizations that cover all subspecialties and primary care.
• At least 3 years of education and training experience, such as teaching coders or providers.
• At least 3 years of coding experience.
• Two current client references who can speak to your audit work. These are submitted with the contract proposal.
• Proof of active credentials, plus a current resume for the proposal.
• Completion of an accredited coding, HIM, or health information technician program.
• Expertise in ICD-10-CM/PCS, CPT, HCPCS, DRG/MS-DRG, APC, E/M, and NCCI edits.
• US citizenship, and the ability to pass a federal background investigation (NACI) and fingerprinting.

Preferred qualifications

• An auditing credential such as CDIP, CPMA, or CIC, in addition to a required credential.
• Experience auditing for the VA or another federal health system.
• Strong report writing and presentation skills, including explaining findings in plain language for non-coders.

Additional requirements

• Complete the VA's annual Privacy and Information Security Awareness and HIPAA training (TMS 10176 and 10203).
• Travel to VA facilities only when the government authorizes it. Approved travel is reimbursed under federal travel regulations.

About Aptive

Arrow ARC supports Veterans Health Administration facilities and offices across the U.S. with health care staffing and program support via the 10-year Integrated Critical Staffing Program (ICSP). We provide staffing solutions to address critical shortages in VHA medical facilities caused by turnover, recruitment issues, seasonal needs, surges or emergencies.

Arrow is a certified Service-Disabled, Veteran-Owned Small Businessjoint venture between Artemis ARC and AptiveResources, two award-winning companies that share an agile, mission-focused, results driven approach in the federal sector. Arrow provides management consulting services and specializes in working with federal government agencies like the Department of Veterans Affairs and Office of Personnel Management.

EEO Statement

Aptive is an equal opportunity employer. We consider all qualified applicants for employment without regard to race, color, national origin, religion, creed, sex, sexual orientation, gender identity, marital status, parental status, veteran status, age, disability, or any other protected class.

Veterans, members of the Reserve and National Guard, and transitioning active-duty service members are highly encouraged to apply.